We’ll Conduct Post-Payment Reviews on Medicaid Claims

July 7, 2026

Beginning Oct. 2, 2026, we’ll conduct post-payment audits of Medicaid member claims to correct billing inconsistencies and ensure coding accuracy and medical policy alignment.

We’ll review current claims, claims within the applicable Medicaid recoverable lookback period, and prospective claims after the program is implemented.   

What happens next? After the review, you’ll receive written notification outlining the findings. If the review determines that payments aren’t supported by the submitted documentation, we may request a refund or apply an adjustment to future claim payments. The notification will include information on next steps or reconsideration options.

More information: To edit or correct a denied claim, learn more about provider appeals and reconsideration requests on our provider website. Watch News and Updates for future updates.

If you have questions, please contact your Provider Relations Representative.