Kentucky Medicaid Surveillance & Utilization Review
Health Care Excel (HCE) has contracted with the Commonwealth of Kentucky to provide services to the Division of Program Integrity of the Department of Medicaid Services to increase its effectiveness in preventing overpayments to providers of Medicaid services. HCE and its subcontractor, Thomson Reuters, is providing knowledgeable surveillance and utilization review services, report interpretation, advanced algorithm-based targeting, intensified provider auditing, and prepayment review. Additional focus is on preventing overpayments by examining the provider enrollment process and heightening the attention to new providers. Expert consultation on self-audit design and “best practice” improvements, plus training, coaching, mentoring, and knowledge transfer, are included.
