HI HB985

Requires the Department of Human Services to implement provider data verification and provider screening technology to prevent overpayment or inappropriate payment to deceased, sanctioned, unlicensed, retired, or incorrectly addressed providers.

Mandates adoption of predictive modeling and analytics technologies into medicaid adult and children's health insurance program claim processing to identify high-risk billing or utilization patterns before claims are paid.

Directs the department to prioritize identified high-risk transactions for additional review before payment and prevent payment of potentially fraudulent or abusive claims until they are automatically verified as valid.

Requires the system to capture outcome information from adjudicated claims to refine and enhance predictive analytics based on historical data and algorithms.