MO HB1155

Department of Corrections shall implement state-of-the-art clinical code editing technology to automate claims resolution, prevent overbilling, and ensure accurate coding based on American Medical Association and Centers for Medicare and Medicaid Services protocols.

Department shall establish correctional health care claims audit and recovery services to identify improper payments, verify diagnosis and procedure codes against medical records, and recover overpayments through post-payment reviews.

Department shall implement automated payment detection and recovery solutions to identify and submit claims for MO HealthNet program reimbursement for eligible inpatient hospital and professional services.

Contractor costs for implementing these services shall be funded through actual savings achieved, with reimbursement models based on percentage of savings, per-beneficiary fees, per-transaction fees, case rates, or blended models that include performance guarantees.

Department may promulgate rules to implement the section's provisions, subject to Missouri's Administrative Procedure Act (Chapter 536).