102-5 Cooperate with Quality Reviews

Effective Date: January 1, 2024

The Department and the eligibility agency conducts reviews of medical assistance cases to determine the accuracy and quality of eligibility decisions made by the eligibility agency, and the accuracy of payments made by the Department with the exception of State CHIP.

Applicants and enrollees of medical assistance will be asked to cooperate with the Department and the eligibility agency to complete these quality reviews.

The Department may contact an applicant or enrollee as part of a quality review.
The applicant or enrollee will be asked to provide complete and accurate information about factors related to the individual's application, medical services received or eligibility.
The Department or eligibility agency may ask the applicant or enrollee to provide verifications of the information being reviewed. The applicant or enrollee will be asked to provide any requested information to the Department or eligibility agency, as applicable, within 10 days of the request. Do not close the case if the applicant or enrollee does not provide the requested information.