Dear Missouri Medicaid Provider,
The Missouri Medicaid Audit and Compliance Unit (MMAC) is the unit within the Department of Social Services (DSS) responsible for oversight and auditing of compliance with the Medicaid Title XIX, CHIP Title XXI, and Medicaid Waiver Programs in Missouri, which include oversight and auditing of MO HealthNet providers. This includes providers who participate in one of Missouri’s four Managed Care Organizations.
MMAC is notifying you that the Centers for Medicare & Medicaid Services (CMS), through its contractor CoventBridge (USA) Inc. (CoventBridge), may randomly select a number of providers to participate in an upcoming Medicaid integrity audit. CoventBridge, the Unified Program Integrity Contractor (UPIC) for CMS in the Midwest Region, is conducting this audit in consultation with the MO HealthNet Division (MHD) and MMAC.
As part of this process, CoventBridge may request medical records from randomly selected providers to verify claims submitted between October 1, 2023, and September 30, 2025, comply with all applicable federal and state Medicaid laws, regulations, and policies.
The requested records will be used to assess the accuracy of claims and ensure adherence to MO HealthNet policies, including those applicable to providers operating within Managed Care Organizations (MCOs).
Provider Responsibilities:
1. Respond to Records Requests:
If you receive a written request from CoventBridge for medical records relating to sampled claims, you are required to respond within the timeframe specified in the request. Timely submission is essential to avoid compliance issues.
2. Legal Compliance:
Under the Deficit Reduction Act (DRA) and other applicable federal and state laws, providers are legally obligated to furnish the requested medical records. Records may be released under HIPAA for Health Oversight Activities authorized by law under 45 CFR 164.512(d). Failure to comply may result in administrative actions as outlined in 13 CSR 70-3.030.
3. Staff Awareness:
Please ensure your administrative staff is aware and understands that correspondence from CoventBridge (USA) Inc. is official and requires prompt attention.
MMAC appreciates your cooperation and your continued commitment to maintaining compliance with Medicaid program requirements.