Step 1: File a Notice of Audit Review
After you receive written notice of a post-payment audit result from MSI, you can file a Notice of Audit Review within 20 business days of receipt of the audit result.
Step 2: MSI reviews your request
The MSI medical consultant will review your request and, if necessary, set up an appointment with you within 15 business days. After considering any new facts you submit, the medical consultant will issue a Notice of Determination, which outlines the findings of the audit, adjustments and details of outstanding issues.
Step 3: File a Notice of Dispute
If you disagree with the Notice of Determination, you can file a Notice of Dispute, which must be submitted within 20 business days of receipt of the Notice of Determination. This initiates the facilitated resolution process.
Step 4: Facilitated resolution
Facilitated resolution involves an informal meeting of you, MSI representatives, medical consultants for DNS and the DHW, and a non-physician facilitator. The goal of this meeting is to resolve the issue through conversation and education. Legal counsel is not permitted to attend this meeting.
If you require assistance navigating the audit appeal process, contact DNS.