“We find that Myers and Stauffer staff are easy to work with and are flexible to the demands of a project, such as coordinating with other Divisions within the Department or working with other vendors to accomplish project tasks.”
— [State] Director of Internal Audit and Program Evaluation

Claims and MMIS Testing

MEDICAID MANAGEMENT INFORMATION SYSTEMS

PAST AND CURRENT SERVICES

  • Perform analysis of claim adjudication to determine compliance with state coverage and reimbursement policies.
  • Develop testing program and agreed-upon procedures based on professional standards. (May include statistically valid sample or focused sample, analysis of the adjudication of fee-for-service claims, managed care capitation claims, administrative fees, or financial transactions, all provider categories and service delivery systems.)
  • Assist in the implementation strategy of a new enterprise system.
  • Provide independent verification and assurances of claim adjudication.
  • Analyze member program eligibility status and rate cell assignments.
  • Analyze the claim adjudication processes to confirm claim processing and financial transaction accuracy.
  • Compute overpayments and underpayments of test claims and/or population estimates.
  • Prepare analysis to assist in prioritizing mispayment issues.
  • Perform analysis of claims population to improve the system editing and auditing of claims.
  • Identify and prepare claims processing system correction tickets.
  • Prepare estimates of the annual financial liabilities and receivables related to paid claims.
  • Perform analysis of system documentation manuals and companion guides.
  • Perform analysis of data matching and/or conversions.
  • Preparation of an agreed-upon procedures report that can be relied-upon by financial statement auditors in order to complete annual audit of financial statements.

 

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Myers and Stauffer has a proven track record of excellent performance.