Article 10 Section 3 Case Review Process

 

Table of Contents

Title

PG Cite

General

10.03.01A

Conducting the Review

10.03.01B

Review Findings

10.03.01C

 

 

10.03.01 Case Review Process

 

10.03.01A
General

QC has access to view the entire case electronically; therefore, paper case folders are no longer requested for review.

 

CMSPG LTR 13 (03/12)

 

10.03.01B
Conducting the Review

The QC worker records all case review data in the Rushmore Case Review System and completes the Print Case Review form.  The Print Case Review form contains pertinent data cited in the desk review.

 

CMSPG LTR 13 (03/12)

 

10.03.01C
Review
Findings

Benefit/Eligibility Error

All benefit/eligibility errors are to be reviewed by the QC supervisor.  Upon completion of the QC supervisor review, the Print Case Review form shall be sent to the appropriate CAS for review and corrective action.

 

Procedural Error

Procedural errors are to be reviewed by the QC supervisor.  Upon completion of the QC supervisor review, the Print Case Review form is sent to the appropriate CAS for review and corrective action.

 

No Error

No errors cases are to be reviewed by the QC supervisor.  Upon completion of the QC supervisor review, the QC worker records in the Rushmore Case Review System that case had no errors.  QC provides the CAS with a complete list of all no error cases reviewed.

 

CMSPG LTR 13 (03/12)