Office of the State Auditor Reviews the State Medicaid Program

Kelsey Creehan Featured News

In October, dentists who participate in Medicaid may have received a notice that the Colorado Office of the State Auditor (OSA) is reviewing the state Medicaid program’s claims processing. It has been difficult to obtain information about this process, as Medicaid and its vendors are not permitted to further discuss the topic. Yet, from our research, it appears that this audit is likely focused on Medicaid and vendor processes (how well they are reviewing and paying claims) as opposed to provider behavior.

This initiative does not appear to be a provider audit. Instead, we believe the state audit may be the result of a recent Medicaid vendor transition (Xerox to HP, aka DXC) on the physical health side that resulted in a lot of provider concerns with timely payments, broken billing systems, etc. This effort may be driven by policy questions from state legislators seeking ascertain whether medical provider concerns with the vendor transition have been resolved.

At this point, we are not aware of any direct outreach to dentists by the OSA, nor any dental provider audits related to the OSA process. We do not expect the OSA audit to impact the dental community at this time, as the dental community was largely insulated from the recent Medicaid vendor transition due to the dental program’s outsourcing to DentaQuest. However, we will keep members informed if this situation changes.