MO SB453

Applies to state correctional healthcare systems and state-contracted managed correctional healthcare services for billing practices.

Requires implementation of clinical code editing technology using American Medical Association and Centers for Medicare and Medicaid Services protocols to identify and prevent overbilling before claims are adjudicated.

Mandates implementation of correctional healthcare claims audit and recovery services to identify improper payments, audit claims, obtain provider sign-off, and recover overpayments based on accurate diagnosis and procedure codes.

Requires implementation of automated payment detection, prevention, and recovery solutions to ensure Medicaid is billed for eligible inpatient hospital and professional services.

Permits the department to contract for required technology services, with reimbursement models based on achieved savings, per beneficiary per month, per transaction, case-rate, or blended approaches, with the state's direct costs funded through actual program savings.