The North Carolina Office of the State Auditor (OSA) has begun the Single State Audit for State fiscal year (SFY) 2020. In accordance with 2 Code of Federal Regulations (CFR) part 200, subpart F, the OSA selects a sample of NC Medicaid claims to determine the State’s compliance with federal award expenditure requirements for claims paid in the prior State fiscal year of July 1 to June 30. The NC Medicaid Office of Compliance and Program Integrity (OCPI) is sending record request notifications to providers with a claim(s) in the sample. In order to minimize costs and prevent delays, OCPI may contact you by telephone to verify the address where the record request should be mailed.
The record request contains a list of all the documents that need to be submitted to OCPI for a successful review of the claim. Requested documents must be submitted as soon as possible and received by OCPI no later than 60 calendar days from the date on your request letter. Failure to submit the requested documents within the allotted time may result in recoupment of the payment associated with the claim.
Fax submissions are strongly encouraged during this time of COVID-19. Please fax the requested medical records to 919-831-1809. As an option, any submittal of more than 35 pages may be sent via encrypted CD or flash drive. The encryption password must be sent separately to medicaid.sa@dhhs.nc.gov.
NOTE: Fax submissions are preferred.
During the record request process, OCPI may need to ask for additional documentation to support review of the claim payment. Failure to timely respond to a request for additional documentation may result in the provider being placed on prepayment claims review.
NC Medicaid is authorized by Section 1902 (a) (27) of the Social Security Act and 42 CFR §431.107 to access patient records for purposes directly related to the administration of Medicaid, the NC Health Choice Program and the Medicaid Waivers. In addition, when applying for Medicaid benefits, each beneficiary signs a release which authorizes access to his/her Medicaid records by NC Medicaid and other appropriate regulatory authorities. Therefore, it is not necessary to require a signed consent from a Medicaid beneficiary for release of records to submit the necessary documentation for this review.
Contact OCPI with any questions at: 919-710-7891