Healthcare Acronyms

Medicaid Integrity Contractor

Includes three types of MICs - audit, review, and education - to ensure that paid claims were for services provided and properly documented, for services billed properly, using correct and appropriate procedure codes, for covered services, and paid according to Federal and State laws, regulations, and policies. Review MICs analyze Medicaid claims data to identify high-risk areas and potential vulnerabilities, provide leads to the Audit MICs, and use data-driven approach to ensure focus on providers with truly aberrant billing practices. Audit MICs conduct post-payment audits, including a combination field and desk MIC audits, fee-for-service, cost report and managed care audits, and identify overpayments. Education MICs use findings from Audit and Review MICs to identify areas for education, work closely with Medicaid partners & stakeholders to provide education and training, will develop training materials, awareness campaigns and conduct provider training, and highlight value of education in preventing Medicaid fraud, waste, and abuse.