[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR456.23]



[Page 343]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 456_UTILIZATION CONTROL--Table of Contents

 

          Subpart B_Utilization Control: All Medicaid Services

 

Sec.  456.23  Post-payment review process.



    The agency must have a post-payment review process that--

    (a) Allows State personnel to develop and review--

    (1) Recipient utilization profiles;

    (2) Provider service profiles; and

    (3) Exceptions criteria; and

    (b) Identifies exceptions so that the agency can correct 

misutilization practices of recipients and providers.