CMS Managed Care Plan audit and record requests for EIDBI and peer recovery services providers

REQUIREMENTS: - Immediately: Billing and administrative teams must establish a process to identify and flag all correspondence from CoventBridge Group related to the CMS Managed Care Plan audit. - Upon receipt of audit requests: Designate a point person (billing manager or compliance officer) to receive and track all CoventBridge Group record requests with their specific deadlines. - Before each deadline specified in CoventBridge Group correspondence: Compile and submit all requested medical and administrative records according to the exact instructions and timeline provided. Ensure records are complete and accurately represent services billed for EIDBI and peer recovery services. - Immediately: If your organization provides EIDBI or peer recovery services, contact your managed care organization's provider services line to verify CoventBridge Group's authorization and clarify any ambiguous requests before submitting records. - Maintain documentation: Keep copies of all audit requests, submission dates, and materials submitted for compliance verification purposes. Consequences of inaction: Failure to respond to authorized CMS audit requests may result in claim denials, contract penalties, or compliance violations with Medicare Advantage and Medicaid managed care agreements.