CMS Clarifies State Vendor Check Requirements

August 5, 2008 at 1:45 pm 2 comments

In case you haven’t seen it yet, The Centers for Medicare & Medicaid Services (CMS) issued a letter to state Medicaid director clarifying the requirements for vendor checks prior to receiving payments. While you may not be a state Medicaid director, if you’re planning to process payments through your state’s Medicaid office, you’ll want to know what they are looking for.

Highlights from the letter:

Frequency of Checks

States are guided to review eligibility at enrollment or re-enrollment as well as monthly. The monthly checks are to identify reinstatements as well as new exclusions.

Who to Check

States are reminded that they must look at out-of-State as well as in-State providers.

Comprehensive Disclosure of Ownership

Because payments to a provider that has an excluded individual as owner (5% or greater) or a managing executive are prohibited, States should be wary of incomplete disclosure information and should not process payments from that company without further research.

You can read the letter yourself here.

Entry filed under: Know Your Vendor, vendor credentials, vendor management.

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2 Comments Add your own

  • 1. The New Standards « Vendor Compliance  |  March 18, 2009 at 3:57 pm

    […] checks need to be done more frequently.  CMS has pushed state level bodies to check at least monthly, and the rate of recidivism is relatively high.  Of all checks, this should certainly be done by […]

  • […] requirement isn’t new, but the momentum is continues. We first noted this in August, 2008. One year later, we posted a list of states that had reinforced the same message. Apparently, the […]


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