Revision : 2
Record Description : Monthly sample reviews, e.g., nursing homes, disabled and aged persons, conducted by quality assessment staff to evaluate recipient eligibility and level of care under the Medicaid program and ensure county offices are providing services in compliance with program and agency operations, procedures, policy and directives as well as state and federal mandates. Files include, but are not limited to, client face sheets which contain information such as name, address, case number, service date, and eligibility determination data, worksheets, review schedules and CPAS (Medicaid claims processing assessment system). Data obtained from these reviews may be used to calculate program error rates and to identify problem areas that would likely benefit from corrective action. Files also include reports of findings and recommendations to improve processes.