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The Department conducts reviews of medical assistance cases to determine the accuracy and quality of eligibility decisions made by the eligibility agency, and the accuracy of payments made by the Department.
Applicants and recipients of medical assistance are required to cooperate with the Department and the eligibility agency to complete these quality reviews.
The Department may contact an applicant or recipient as part of a quality review.
The applicant or recipient is required to provide complete and accurate information about factors related to the client's application or eligibility to the Department and the eligibility agency.
The Department may ask the applicant or recipient to provide verifications of the information being reviewed. The applicant or recipient will be asked to provide any requested information to the Department within 10 days of the request. Do not close the case if the applicant or enrollee does not provide the requested information.