Cal. Code Regs. Tit. 22, § 51460 - Special Claims Review

(a) The Department may place any provider on special claims review for specific or all services provided. The special claims review may be performed by the Department, or by the fiscal intermediary under direction of the Department. Special claims review may be imposed on a provider upon a determination that the provider has submitted improper claims, including claims which incorrectly identify or code services provided.

(b) A provider, while on special claims review, shall furnish any material requested by the Department in order to substantiate specific or all claims subject to special claims review.

(c) The Department shall provide written notice to any provider placed on special claims review. The written notice shall include the following:

(1) Services determined to have been improperly billed by the provider.

(2) Services subject to special claims review.

(3) Documentation to be submitted with all claims subject to special claims review.

(4) Instructions for submission of claims subject to special claims review.

Notes

Cal. Code Regs. Tit. 22, § 51460

1. New section filed 12-20-78; effective thirtieth day thereafter (Register 78, No. 51).

Note: Authority cited: Sections 14105, 14124.5, and 14133(b), Welfare and Institutions Code. Reference: Sections 14104.5 and 14133(b), Welfare and Institutions Code.

1. New section filed 12-20-78; effective thirtieth day thereafter (Register 78, No. 51).