Provider Requirements

Provider Requirements

We have created the resources below to help states with a range of topics in provider management including enrollment, ownership and control, payments, and more. States can also use these resources to educate providers and improve compliance. Most of the resources are short fact sheets that provide high-level information on topics. We also provide frequent findings from State Program Integrity Reviews on select topics in provider management.

General

• Introduction to Medicaid Fact Sheet (PDF) (2 pages)
• The Role of Brokers in the Medicaid Program Fact Sheet (PDF) (2 pages)

Enrollment

• Frequent Findings on Federal Database Checks (PDF) (5 pages)

Ownership and Control

• Frequent Findings on Disclosures of Ownership and Control (PDF) (17 pages)
• Fiscal Agents: Disclosure of Ownership and Control Fact Sheet (PDF) (2 pages)
• Frequent Findings on Disclosures of Business Transactions (PDF) (3 pages)
• Disclosure of Business Transactions with Subcontractors and Wholly Owned Suppliers Fact Sheet (PDF) (2 pages)
• Corporate Integrity Agreements Fact Sheet (PDF) (2 pages)

Criminal Background

• Frequent Findings on Disclosures of Healthcare-Related Criminal Convictions (PDF) (3 pages)
• Sanctions for Provider Misconduct Fact Sheet (PDF) (2 pages)

Payments

• Corrective Actions to Prevent Improper Payments Fact Sheet (PDF) (2 pages)
• Medicaid Payment Suspension Toolkit (PDF) (7 pages)
• FAQ on Allowability of Using NPIs for Medicaid PCAs (PDF) (4 pages)
• Frequent Findings on Notifications to the HHS OIG (PDF) (5 pages)
• Payment Error Rate Measurement (PERM) Program Fact Sheet (PDF) (2 pages)

Resources to Assist Providers

• Provider Self-Audit Fact Sheet (PDF) (2 pages)
• Payment Suspensions Fact Sheet (PDF) (2 pages)
• Medicaid Recovery Audit Contractors Fact Sheet (PDF) (2 pages)