State of Missouri
Single Audit
Corrective Action Plan
Year Ended June 30, 2023
State Agency: Department of Social Services (DSS) – MO HealthNet Division (MHD)
Audit Finding Number: 2023-001 - Medicaid National Correct Coding Initiative
Name of the contact person responsible for corre...
State of Missouri
Single Audit
Corrective Action Plan
Year Ended June 30, 2023
State Agency: Department of Social Services (DSS) – MO HealthNet Division (MHD)
Audit Finding Number: 2023-001 - Medicaid National Correct Coding Initiative
Name of the contact person responsible for corrective action: Kim Johnson
Anticipated completion date for corrective action: July 1, 2024
Recommendation: The DSS through the MHD continue to strengthen controls over the NCCI requirements to ensure claims are reprocessed when NCCI edits are not implemented timely, as required.
DSS Response: DSS agrees with the auditor’s recommendation. The Corrective Action Plan includes the department’s planned actions to address the finding.
Corrective action planned is as follows: The DSS through the MHD will continue to update the NCCI edits quarterly, within the Centers for Medicare & Medicaid Services (CMS) requirement that the files must be implemented by the beginning of the second month of the calendar quarter. MHD will reprocess January 1, 2023, through February 17, 2023. MHD is not reprocessing claims submitted July 1, 2022, through August 22, 2022, as the system changes were not in place until August 23, 2022. Any claims for this time frame submitted after August 22, 2022, were subject to the updated NCCI edits. Moving forward, claims will be reprocessed when changes are not in the system, as required by CMS.