Post-payment audit

Post-payment audit

If you have been audited by MSI, you have the right to dispute the audit result. Remember that this process is time sensitive, so it’s crucial to read MSI correspondence promptly.

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.

Contact

Jessica Moore
Compensation manager, Master Agreement and Fee Schedule
902-481-4922
1-800-563-3427 ext. 4922