State of Alabama
09/03/2024 | Press release | Distributed by Public on 09/03/2024 09:18
Medicaid Recovery Audit Contractor (RAC) Audits
TO: All Medicaid Providers
RE: Medicaid Recovery Audit Contractor (RAC) Audits
Mandatory provisions of the Affordable Care Act require the Alabama Medicaid Agency (Medicaid) to select and provide oversight for a Medicaid Recovery Audit Contractor (RAC) to perform provider audits. Alivia Analytics, LLC (Alivia) was selected to be Medicaid's RAC effective October 1, 2024. The RAC program is designed to improve payment accuracy by identifying under and overpayments in Medicaid. The Medicaid RAC program is a separate program from the Medicare RAC which is overseen by the Centers for Medicare and Medicaid Services.
Reviews will be conducted by Alivia staff to include a medical director, certified professional coders, and experienced clinicians. Audits will be conducted by Aliviausing a "top down" approach where data analysis, through data mining, is applied against the universe of paid claims to identify patterns of utilization or billing which look atypical based on Medicaid and/or national standards. Following the high-level claims analysis, Alivia may expand its review by requesting clinical records and/or other documents in accordance with state and federal regulations.
Alivia has been informed of the critical role that all providers play in a successful Medicaid program and requires that auditors be professional, objective, and consistent in performing all required audits/reviews.
Providers are reminded that the Alabama Administrative Code, the Provider Manual, and their Provider Agreements require compliance with requests for medical records for Medicaid program audits.
Questions regarding the audits should be directed to Jamie Cousins, RAC Program Manager, at (334) 353-8025 or [email protected]or Yulonda Carter, Recipient Review Associate Director, at (334) 242-5161 or [email protected].
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