VA Medicaid: Behavorial Health
Virginia Medicaid: Behavioral Health Provider Audits & Clinical Reviews
The Department of Medical Assistance Services (DMAS) has contracted with HMS to perform audits/clinical record reviews of Community Mental Health Rehabilitative Services and other Behavioral Health Services. Specifically, HMS is auditing and clinical record reviews for the following participating provider services: Crisis Intervention, Crisis Stabilization, Intensive Community Treatment, Intensive In-Home Services, Mental Health Case Management, Mental Health Skill-Building Services, Psychosocial Rehabilitation and Therapeutic Day Treatment.
HMS and DMAS are working closely together during this auditing/clinical record reviews contract to ensure that Virginia Medicaid Individuals receive the appropriate behavioral and community mental health services in the appropriate setting. HMS also ensures that services received by Virginia Medicaid Individuals are performed in accordance with best practices, federal and state guidelines, in addition to guidelines set forth in the Medicaid Manuals.
HMS will provide education on the medical record review process, the appeals process, communicate review trends and common errors. This website will also function as a means to project information to the providers that serve Virginia Medicaid Individuals.
Click here for the following information:
- Introduction to the HMS Team
- HMS Background, Goals and Objectives
- Medical Record Review Process
- Clinical Review Items
- Allowable Degrees for Human Services
- DMAS Appeal Process
- Provider Letter
- HMS Contact Information
- Provider Survey
- Manual Updates
- Findings Report Example
- How to Request an Appeal
- Links to DMAS Policy & Federal Regulations
- Frequently Asked Questions
Questions or inquiries regarding the Virginia Behavioral Health Provider Audits and Clinical Reviews can be sent to:
Kathleen Moore, LPC, CSAC, CFE