The Contract Compliance Branch provides contract oversight to assure that the Managed Care Organizations (MCOs) contracted with the Department for Medicaid Services (DMS) are compliant in all aspects to consistently provide reliable health care to Kentucky's Medicaid managed care members
Contract Compliance Branch staff is a liaison between the MCOs and DMS and a point of contact coordinating communications and connecting subject matter experts. Staff also partners with sister agencies such as DBHDID, DCBS and DPH on related Medicaid managed care issues providing oversight consistency in contractual activities.
Responsibilities of branch staff include:
- Specialization in all areas of contract compliance oversight
- Reviewing and assessing encounter reports for accuracy and imposing late fees and capitation withholdings when the records are noncompliant
- Issuing letters of concern and corrective action plans (CAP) when MCO activities are found contractually deficient
- Reviewing and approving CAPs when MCO activities are found to be substantially noncompliant with any material provision of a contract, such as breaches of member personal health information
- Approving MCO marketing and outreach documents for the Medicaid managed care members
- Attending community events to assure MCOs are adhering to marketing materials distribution in compliance with their contract
- Facilitating MCO encounter file submission and resubmission in conjunction with the Office of Administration and Technology Services and Hewlett Packard
- Conducting MCO provider network adequacy reviews
- Maintaining MCO contacts directories
- Conducting onsite and offsite contract compliance audits
- Facilitating monthly MCO operations meetings
- Assisting colleagues in MCO contractual obligations specifically required for program and project activities.
- Monitoring monthly, quarterly and annual MCO reports.
Provider Lock-In Information
The Lock-In Program was developed to identify, manage and monitor members who use Medicaid services at an amount or frequency that is not medically necessary in accordance with established utilization guidelines.
If a member is enrolled in a MCO, please contact the specific MCO for more information.