Montana Medicaid Recovery Audit Contract
The Affordable Care Act (ACA) requires Medicaid agencies to contract with Recovery Audit Contractors (RACs) to identify and recover overpayments and underpayments made to Montana Medicaid Providers. States must develop processes for entities to appeal RAC determinations, and coordinate RAC efforts with other Federal and state law enforcement agencies.
Medicaid RACs collaborate with state agencies to ensure claims are appropriately paid.
Montana entered in to a contract with Health Management Systems (HMS) on December 15, 2012. The contract concluded on July 31, 2017. A request for proposal will be posted soon.
Montana and HMS work together to create audit scenarios outlining an audit process. The current audit scenario can be found here.
For more information about RAC
Recovery Audit Coordinator
Krista Cronholm, Interim
HMS - Montana Providers