42 C.F.R. § 456.23 Post-payment review process.
Title 42 - Public Health
The agency must have a post-payment review process that— (a) Allows State personnel to develop and review— (1) Recipient utilization profiles; (2) Provider service profiles; and (3) Exceptions criteria; and (b) Identifies exceptions so that the agency can correct misutilization practices of recipients and providers.
Title 42: Public Health
PART 456—UTILIZATION CONTROL
Subpart B—Utilization Control: All Medicaid Services
§ 456.23 Post-payment review process.
