1. A. The department may require a provider’s claims be subject to a pre-payment or post-payment review.
2. B. The decision to implement a pre-payment or post-payment review is not a sanction, cannot be appealed, and is not subject to an informal hearing.
3. C. Pre-payment and post-payment review may be limited to specific items or procedures. It may also include all billings or claims a provider submits.
4. D. The duration a provider is on pre-payment or post-payment review shall be at the discretion of the BHSF director or the PIU section chief.
5. E. A department assessed sanction resulting from a post-payment review is appealable and subject to an informal hearing.

Authority Note

AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and 46:437.1-46:440.3.

Historical Note

HISTORICAL NOTE: Promulgated by the Department of Health, Bureau of Health Services Financing, LR 52:691 (May 2026).