2012 Audit by Texas HHSC-OIG on Medicaid Orthodontic Pre-Approval Requests Now Available Online
PR Web |
Texas Dentists for Medicaid Reform has released on their website an
This past February TDMR placed online an earlier
The 2012 audit and its results were first announced by
Pg 16 of the slide presentation states:
"Follow-up audit of TMHP was conducted in conjunction with the U.S.
• TMHP is not hiring medically knowledgeable personnel to process dental prior authorization requests as contractually required
• The dental director is not approving all orthodontic prior authorization requests
• TMHP’s Quality Assurance Review tool does not address medical necessity
• TMHP is approving multiple prior authorization requests for the same client and the same service"
However, per the audit document, TMHP disputed each of the findings.
Excerpts from the audit document states:
"Background
"Finding 1 – TMHP is not hiring medically knowledgeable personnel
TMHP is not hiring medically knowledgeable personnel to process dental PA requests as required by the contract… As a result, more orthodontic PAs were approved, which has resulted in the
"Finding 2 – Dental Director is not approving all orthodontic PAs
…Through dialogue with TMHP staff and in reading the audit and SAR [State Action Request] responses, HHSC staff believed TMHP was applying the approved medical policy requirements and criteria in making decision to approve or deny the orthodontic PAs. It now appears that TMHP staff never reviewed the diagnostic tools required to be submitted that were necessary to enable TMHP to make a determination of medical necessity. It also appears that the diagnostic tools were never imaged and that some were destroyed.
"TMHP further states that they did not receive any additional direction from HHSC as a result of the audit [2008] or the findings to change the prior authorization process. HHSC disagrees with this statement. HHSC began meeting with TMHP in
For more information, see the full article on the TDMR website.
Read the full story at http://www.prweb.com/releases/texas-oig/2012-tmhp-audit/prweb11430846.htm
Copyright: | (c) 2013 PRWEB.COM Newswire |
Wordcount: | 665 |
Advisor News
Annuity News
Health/Employee Benefits News
Life Insurance News