Recovery Audit Contractor (RAC)

The State of Missouri, Department of Social Services, Missouri Medicaid Audit and Compliance, contracted with Cognosante to be its Medicaid Recovery Audit Contractor (RAC) with a contract effective date of December 1, 2011. Cognosante is based in McLean, Virginia with offices in Scottsdale, Arizona and in Fargo, North Dakota. Cognosante is also the NPI Enumerator for CMS and has helped more than three million providers nationally obtain NPI numbers for electronic billing and other functions through its call center in Fargo.

Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor and allows states to reimburse contractors who assist in the identification and recovery of improper payments.  This was based on the success of a pilot RAC Program for Medicare. The mission of this Program is to reduce improper payments in Medicaid through the efficient detection and collection of overpayments, the identification of underpayments and the implementation of actions that will prevent future improper payments.

This is an entirely separate Program from the Medicare RAC since Cognosante is contracted with the state rather than with CMS.

Cognosante will review three (3) program areas for RAC Audits – retail pharmacy, behavioral health services, and DME.  Missouri Medicaid providers enrolled in these program areas will be reviewed for improper payments beginning mid-November, 2012, and corresponding overpayment (demand) letters will be sent by Cognosante, on behalf of MMAC.

Traditionally, MMAC postpayment review audits focus on medical records documentation.  Cognosante will conduct post payment audits driven by established industry rules and standards on claims.

Please follow directions in the letter regarding questions, repayment options, and appeals.

Cognosante will have a Call Center available for RAC questions/issues related to audits.

For non-audit RAC comments/concerns, please direct comments or questions to email address .