Question Inquiries
How many days does the SME have to accept and start working on a Question Inquiry?
5 days
What is the final TAT for Customization/Modification requests?
90 days
How many times a year do Cotiviti PURs occur?
Quarterly: Q1 March, Q3 July, Q4 October
How often does a Medicaid HP receive CXT New State Rules for review?
Once a month
Cotiviti NPP MEU analysis comes back with the following: gross savings $91,142. Total claims 4,140, PMPM .03. Would this be an SAI or Non-SAI?
What is the final TAT for a Question Inquiry?
15 days
What status does the SME update the QB issue with when sending a request for review by Jackie for approval?
Work in Progress or Additional Research/Internal
How many times per year do Cotiviti NPP occur?
Once per year per HP
MPPS SME emails the CXT New State Rule policies to the HP governance team for review. How many weeks does the HP have to make decisions?
3 weeks
A Non-SAI implementation date verified and past effective date, what status does the SME use to close out this SAI project?
Complete Non-SAI
PPM SME needs to send a question to the HP requestor for additional information- what status is updated in the QB issue?
Sent to Requestor-1st
HP is requesting to exclude a provider TIN from DP 8290, does this require Jackie’s approval?
Yes
The HP has additional questions after the Cotiviti presentation. What should the SME do?
Send CIP inquiry to Cotiviti asking the additional questions.
If the HP has questions about the CXT new policies, what does the SME do?
Review the policy excel and see if SME can answer (ex, how to interpret age criteria, less/greater than). If SME can’t answer send email to Jackie/Betty/Susan J for review.
A Cotiviti NPP is considered an SAI after MEU analysis. FTE/Staff funding review is not required. What status does the SME update the SAI project with?
Request Department Approval
HP is asking question on a claim regarding Cotiviti Post-Pay editing. What does the PPM SME do?
Reach out to Susan Heller to see if Cotiviti post pay, date mining, or Equian. SME should respond to requestor that this is Cotiviti Post-Pay and provide the email address recommended by Susan Heller.
Creating Vendor Implementation (VI) request: if there are 4 or more DPs what does the PPM SME do?
Email VI team (Robin Hill, Christina Greene, Chad Hale, Shari Masse) to create a ‘grouping’ (Cust/Mod Step 16 C Note#2)
The HP has not made decisions in 3 weeks. SME sent follow up email giving HP 2 more weeks for decisions. Still no decisions. What should the SME do?
Escalate to Jackie either by email or on 1:1 call depending on timing of this call.
True of False- The effective date for the CXT new policies will be the same as the CXT promotion date
False- effective dates need to be the 1st of the month following the CXT promotional date
After the SAI is implemented and past effective date, what status does the SME use to close out the SAI project?
Complete