CT SB00243

Requires the commissioner to provide at least 30 days' written notice before auditing a medical assistance provider, including the sampling methodology, unless there is a good faith determination of health/safety risk or vendor fraud.

Requires disclosure at audit commencement of the auditor's name and contact information, audit location, submission methods, and types of information to be reviewed.

Limits audits to claims from no more than 36 months prior to the date claims are selected and prohibits application of new policies, guidelines, or updated medical payment codes retroactively unless previously distributed to the provider.

Establishes that providers must be given at least 30 days to provide documentation for discrepancies and specifies acceptable proof for written orders (photocopies, facsimiles, electronic documents) and delivery of services (signed receipts or shipping documentation).

Requires the commissioner to establish and publish audit protocols for specific provider categories and ensure auditors include or consult with medical or dental professionals experienced in electronic medical records and the relevant treatment, billing, and coding procedures.