Department of Health
Medicaid Managed Care Encounter Data (Follow-Up Review) Each month, managed care providers are required to submit to the Department of Health information describing the medical services provided to Medicaid recipients. In our prior audit report 2000-S-54, we examined the practices used by the Department to ensure that the information submitted by managed care providers (called encounter data) was complete, accurate and timely. We found that a number of improvements were needed, as some of the medical services provided to Medicaid recipients were not reported and the reported information was not always complete or reliable. We also found that encounter data could be used more effectively by the Department in its efforts to monitor the services provided to Medicaid recipients. In our follow-up review, we found that actions had been taken to implement most of the recommendations contained in our prior report.
For a complete copy of Report 2003-F-45 click here.