The vendor is required to provide medicaid and non-medicaid billing verification audit services for agency directly operated programs and it’s contracted vendors, including both the mental health and substance use disorder networks.
- This guideline establishes operational policy; minimum procedures and reporting requirements for verification of medicaid/healthy state claims/encounters provided to beneficiaries under this contract.
- The audit services for this period will include one hundred percent (100%) of the agency network.
- The awarded bidder is required to conduct services that conform to generally accept auditing standards.
- The bidder is expected to demonstrate experience with governmental accounting, generally accepted accounting principles, and apply knowledge of government accounting standards board pronouncements.
- Bidders are required to have appropriate staff to generate the sampling methodology, conduct the audit with staff trained on the agency billing verification requirements, and produce reports as required by agency.
- The audit process will verify the existence of clinical records for each claim in the audit sampling.
- The audit will also verify the reasonableness of the clinical record associated with each claim and instructions will be provided on a vendor-by-vendor basis as to what each record should contain as it pertains to the service line.
- The audit will also verify that the services specified in the claim are part of the person(s) served service.
- The bidder shall be able to demonstrate competency and knowledge of the state mental health system county specific knowledge is preferred.
- The bidder must include the cost of the following, including only those costs at a rate at which they will actually be billed so that hours can be evaluated:
•Estimated hours on the assignment for each classification of personnel;
•Rate per hour for each classification of personnel;
•Maximum total fee to conduct the audit; and
•Maximum total expenses to conduct the audit.

- Contract Period/Term: 2 years