Respond to a Pre-payment Audit Notification from HMS
Respond to a Pre-Payment Audit Notification from HMS: Please follow the steps outlined in the letter you received from HMS. You could also use following links as a reference:
Vendor Resources
Zelis
We partner with Zelis for claims editing services for Medicaid products. In response to inquiries about the adjustment codes, we have developed reference materials that includes sourcing and examples explaining why an edit is triggered. Zelis is considered a business associate of Sentara Health Plans, as defined by HIPAA. You may disclose protected health information (PHI) to Zelis without prior written participant authorization or consent. Zelis will perform periodic reviews of medical records to ascertain and/or verify charges billed to Sentara Health Plans.
Zelis will provide services including, but not limited to:
- ICD-l0 alignment with CPT/HCPCs coding accuracy
- clinical chart review
- laboratory coding
- coding and modifiers
- encourage follow-up visits via telehealth when appropriate to the principal diagnosis
- submit claims and encounter data timely