Mandatory provisions of the Affordable Care Act require the Medicaid Agency (Medicaid) to select and provide oversight for a Medicaid Recovery Audit Contractor (RAC) to perform provider audits. Alivia Analytics, LLC (Alivia) was selected to be Medicaid’s RAC effective October 1, 2024. The RAC program is designed to improve payment accuracy by identifying under and overpayments in Medicaid. The Medicaid RAC program is separate from the Medicare RAC overseen by the Centers for Medicare and Medicaid Services.
Reviews will be conducted by Alivia staff to include a medical director, certified professional coders and experienced clinicians. Audits will be conducted by Alivia using a “top down” approach where data analysis, through data mining, is applied against the universe of paid claims to identify patterns of utilization or billing which look atypical based on Medicaid and/or national standards. Following the high-level claims analysis, Alivia may expand its review by requesting clinical records and/or other documents in accordance with state and federal regulations.
Alivia has been informed of the critical role that all providers play in a successful Medicaid program and requires that auditors be professional, objective and consistent in performing all required audits/reviews.
Providers are reminded that the Alabama Administrative Code, the Provider Manual and their Provider Agreements require compliance with requests for medical records for Medicaid program audits.
Questions regarding the audits should be directed to Jamie Cousins, RAC Program Manager, at (334) 353-8025 or Yulonda Carter, Recipient Review Associate Director, at (334) 242-5161.
Also in Alabama, the State Board of Pharmacy will transition to a new database in October of this year. The new system and the renewal process will look different. The changes will ultimately be positive but require you to create a new account to renew licenses, permits and registrations.
Finally in Alabama, as a reminder, 2024 is a year for pharmacist license renewals and pharmacy permit renewals.
For more information, contact NACDS’ Leigh Knotts at 803-243-7207.