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Colorado Paid Over 800 Thousand Medicaid Claims With Missing or Invalid National Provider Identifiers During 2011

The Colorado Department of Health Care Policy and Financing (State agency) lacked sufficient internal controls to ensure that Medicaid claims submitted by providers and paid by the State agency during fiscal year (FY) 2011 correctly included National Provider Identifiers (NPIs) as specified in Federal requirements. As a result, the State agency was unable to prevent the reimbursement of Medicaid claims that had missing or invalid NPIs.

Although it upgraded and enhanced its Medicaid Management Information System (MMIS) beginning in FY 2007, the State agency did not implement sufficient internal controls, in the form of system edits in its MMIS, to prevent claims with missing and invalid NPIs from being submitted for, and receiving, Federal reimbursement. In addition, the State agency did not address any of the Federal requirements regarding the use of NPIs in its State Medicaid plan.

Filed under: Center for Medicare and Medicaid Services