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Audit (A-01-10-00009)

Review of American Recovery and Reinvestment Act of 2009: Medicaid Prompt Pay Requirements in New Hampshire

Executive Summary

We could not determine that New Hampshire fully complied with the prompt pay requirements for receiving the increased Federal Medical Assistance Percentage under American Recovery and Reinvestment Act of 2009 (Recovery Act) because we could not determine that the State agency always recorded claim receipt dates as the actual days that it received paper or electronic claims from providers. As a result, we could not rely on the State agency's receipt dates to verify that it paid 90 percent of all clean claims from providers within 30 days of receipt and 99 percent of all clean claims within 90 days of receipt. The State agency's policies and procedures did not ensure that it always recorded a claim's receipt date as the actual day that it received the claim.

Pursuant to the Social Security Act, the Federal Government pays its share of a State's medical assistance expenditures under Medicaid based on the Federal medical assistance percentage (FMAP), which varies depending on the State's relative per capita income. For the recession adjustment period (October 1, 2008, through December 31, 2010), the Recovery Act provides an estimated $87 billion in additional Medicaid funding based on temporary increases in States' FMAPs. Federal regulations require State Medicaid agencies to pay 90 percent of all clean claims from practitioners within 30 days of the date of receipt. A clean claim is a claim that can be processed without obtaining additional information from the provider or a third party.

We recommended that the State agency implement policies and procedures to ensure that it records a claim's receipt date as the actual day that it receives the clean Medicaid claim. Specifically, we recommend that the State agency record the receipt date as the day that it receives a claim (1) by mail for paper claims or (2) at the Translator for electronic claims.

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