Medicaid/CHIP Data Requirements |
Annual audited financial statements - 28 Pa. Code § 912.61 |
Hospitals and ambulatory service facilities must annually file audited and certified financial statements within 120 days after the close of the... |
Annual cost reporting - 55 Pa. Code § 1151.47 |
Inpatient psychiatric facilities must complete form MA 336 (Financial Report for Hospital and Hospital-Health Care Complex Under the Medical... |
Cost reporting - 55 Pa. Code § 1181.64 |
Each nursing facility must submit a cost report to the department of welfare within 90 days of the close of each fiscal year. The cost report... |
Cost reporting - 55 Pa. Code § 1187.71 |
Nursing facilities must report costs to the medical assistance program by filing an acceptable MA-11 with the department of welfare, which includes... |
Cost reports - 55 Pa. Code § 1163.64 |
Hospitals must complete form MA 336 (Financial Report for Hospital and Hospital-Health Care Complex Under the Medical Assistance Program of the... |
Medicare cost reports and Medical Assistance Form 336 - 28 Pa. Code § 912.63 |
Hospitals and ambulatory care facilities must quarterly report summary utilization and financial reports to the council. 28 Pa. Code Chapter 912,... |
Ongoing responsibilities of providers - 55 Pa. Code § 1121.42 |
As a condition of participation in the medical assistance program, pharmacies must permit authorized officials to conduct onsite reviews for the... |
Ongoing responsibilities of providers - 55 Pa. Code § 1153.42 |
Outpatient psychiatric clinics and outpatient psychiatric partial hospitalization facilities must include the following information in the medical... |
Ongoing responsibilities of providers- 55 Pa. Code § 1101.51 |
Recipients of medical assistance may obtain services from any institution, agency, pharmacy, person or organization that is approved by the... |
Participation requirements - 55 Pa. Code § 1140.41 |
The Healthy Beginnings PLUS Program (HBP) is a comprehensive package of prenatal and postpartum services provided to eligible medical assistance... |
Payment conditions for various services - 55 Pa. Code § 1121.52 |
Medical assistance prescriptions must contain the following information on the prescription form:1
The... |
Provider fraud - 55 Pa. Code § 1101.4 |
If the department of public welfare determines after an investigation that a provider participating in the medical assistance program has submitted... |
Provider misutilization and abuse - 55 Pa. Code § 1101.73 |
If the department of public welfare’s routine utilization review procedures indicate that a provider participating in the medical assistance... |
Recipient misutilization and abuse - 55 Pa. Code § 1101.91 |
Providers must notify the local County Assistance Office if he has reason to believe that a recipient is mis-utilizing or abusing medical assistance... |
Required data elements - 28 Pa. Code § 912.21 |
Health care facilities must quarterly submit the following data elements:1
Those contained in health... |
Responsibilities relating to provider performance - 55 Pa. Code § 1102.34 |
The operator of a shared health facility must insure that providers rendering services to recipients at the facility and persons employed by the... |
Responsibilities relating to the provision of medical services - 55 Pa. Code § 1102.33 |
The operator of a registered shared health facility must do the following:
Insure that a recipient is treated by a practitioner who is familiar... |
Scope of claims review procedures - 55 Pa. Code § 1121.71 |
Claims submitted by pharmacies under the medical assistance program are subject to utilization review. 55 Pa. Code Chapter 1121, “Scope of... |
Special participation requirements for shared health facilities - 62 Pa. Stat. Ann. § 1403 |
The minimum care requirements for a shared health facility are as follows:
Maintain proper recipient records which contain the following... |
Special Provider Participation Requirements - 62 Pa. Stat. Ann. § 1402 |
As a condition of participation in the medical assistance program, a provider must maintain appropriate medical and financial records to fully... |
Utilization control - 6 Pa. Code § 22.81 |
Providers enrolled in the Pennsylvania Pharmaceutical Assistance Contract for the Elderly (PACE) Program must provide the following information:... |