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What triggers a Medicaid audit?

What triggers a Medicaid audit?

Those receiving the greatest amounts of Medicaid payments are also the ones most likely to be audited. Additionally, fines and penalties can be added by the Medicaid program. However, you can eliminate or reduce the amount of any such repayment by actions taken both before and during the Medicaid audit.

Who audits Medicaid?

What are the Audit MICs? Audit Medicaid Integrity Contractors (Audit MICs) are entities with which CMS has contracted to conduct post-payment audits of Medicaid providers. The overall goal of the provider audits is to identify overpayments and to ultimately decrease the payment of inappropriate Medicaid claims.

How do I contact Medicaid NC?


  1. NC Medicaid Contact Center – Provider and beneficiary information on Medicaid and NC Health Choice policies and procedures. Phone: 888-245-0179.
  2. NCTracks Contact Center – Provider information for claims and billing. Phone: 800-688-6696.
  3. Patrick Doyle, Director. Phone: 919-855-4100.
  4. John E. Thompson, Director.

What is the difference between NC Medicaid and NC Health Choice?

Once parents are notified, the child is eligible to receive care. Unlike Medicaid, the NC Health Choice for Children program is limited by the amount of funds that are available. Therefore, it is open only to children on a first come, first served basis.

Do doctors get audited?

Physician practices are audited all the time. It may even be considered a routine occurrence in your office. Not all audits are routine, however, and it’s important to make sure you know who is asking for charts and the reason for audit before shipping off requested documents.

Does NC Medicaid accept paper claims?

No paper submission is required – secondary claims can be billed electronically to NCTracks, either on the portal or as a batch electronic claims transaction.

What is the income limit for NC Medicaid?

Who is eligible for North Carolina Medicaid Program?

Household Size* Maximum Income Level (Per Year)
1 $17,131
2 $23,169
3 $29,207
4 $35,245

How is Medicaid being managed in North Carolina?

In 2015, the NC General Assembly enacted legislation directing DHHS to transition Medicaid and NC Health Choice from fee-for-service to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services.

How to become State Auditor of North Carolina?

Opportunity Is Knocking! The Office of the State Auditor is looking to hire bright, talented and hard-working professionals who want challenging careers, top-notch training and a healthy work/life balance. More About Careers at NC OSA… More Contact Info…

Who is the Medicaid Ombudsman in North Carolina?

The NC Medicaid Ombudsman is a resource to help Medicaid beneficiaries learn more about NC Medicaid Managed Care, understand their rights and responsibilities, and receive referrals for other services that they may need.

How to contact a Medicaid provider in NC?

NC Medicaid Contact Center Phone: 888-245-0179