Retrospective Post Payment Claim Review 2019 Q1 Documentation Requirements

OutPatient Review Objective: sleep studies • Physician’s Order(s) for Polysomnography and/or Multi Sleep Latency Test (MSLT) • All sleep studies, initial and subsequent, related to dates of service not requested elsewhere • Documentation to include: o Diagnosis o Sleep history, sleep assessment and/or sleep diary o Summary of findings - Results of sleep study o Recommendations from sleep study o Follow-up related to compliance with recommendations o Sleep laboratory location Note: Providers must submit the signed doctor’s order and initial evaluation regardless of the dates of service under review. Without these documents, KEPRO will deny the case.

Outpatient review objective: Prenatal services

Inpatient review objective: same day admission and Discharge

Inpatient review objective: Inpatient Rehabilitation and Long-Term Acute Care Hospital Stays

Additional documentation requests During the review process, the Nurse Reviewer may need additional documents. A message will be entered into the Atrezzo Portal A Letter will be sent via fax listing the additional documents needed to complete the review. When the documents have been pulled and are ready for upload they must be uploaded to the Case ID number listed on the letter.

Review Completion Once the Nurse Reviewer completes the review a message will be put into the Atrezzo Portal as follows: “The Minnesota Department of Human Services (DHS) will review the results of the reviews. DHS will contact the provider only if follow up is indicated. No action is required at this time.”