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.
Missouri contracted with Cognosante, LLC in December, 2011 to serve as Missouri’s RAC.
Also, as part of the Deficit Reduction Act of 2006, the Medicaid Integrity Program was established. This program utilizes Medicaid Integrity Contractors (MICs) to analyze Medicaid claims data to identify high-risk areas and potential vulnerabilities, as well as conduct post-payment audits.
Missouri’s MIC is Health Integrity, LLC. The MICs are assigned by geographic location.
Both the RAC and the MIC may utilize subcontractors. A list of the contractors’ and subcontractors’ names is located below. Should you receive any communication from an entity representing itself on behalf of Missouri Medicaid Audit and Compliance (MMAC), or one of the companies listed below, and you are concerned about the legitimacy of the person or company, you should contact MMAC at (573) 751-3399 to verify the communication or request is legitimate.
Currently, Missouri’s MIC is conducting audits of Missouri hospice providers. The MIC may request documentation that supports Medicaid-enrolled participants’ eligibility for hospice, and other documents to ensure proper billing.
The Missouri RAC is preparing to conduct audits of enrolled Missouri pharmacy providers. The RAC will be reviewing paid claims for proper billing, and to ensure the claims were not paid twice (duplicate billing) and that proper quantities were billed. They may request documentation to include items such as a copy of the original prescription, the dispensing record, documentation of offer to counsel, and the signed delivery record.
The RAC is also preparing to conduct audits of enrolled Missouri durable medical equipment providers. The RAC will be reviewing paid claims for proper billing, and to ensure the claims were not paid twice (duplicate billing). They may request documentation to include items such as precertification and prior authorization forms and supporting documentation, prescriptions, physician’s orders, invoices, proof of delivery, and certificate of medical necessity.
Medicaid Integrity Contractor (MIC): Health Integrity, LLC
Recovery Audit Contractor (RAC): Cognosante, LLC
Recovery Audit Specialists LLC