The Ohio ADAMHS Boards are mandated by law to perform Community Medicaid Compliance Reviews and Medical Necessity Documentation Reviews pursuant to Ohio Administrative Code sections 5101:3-27-02, 5101:3-27-06 and the requirements of the Ohio Department of Mental Health standards.

The purpose of performing the Community Medicaid Compliance Reviews is to identify areas that may potentially trigger repayments resulting from ineligible billings, or other problems. The purpose of conducting the Medical Necessity Documentation Review is to provide a safeguard against unnecessary and/or inappropriate use of Medicaid services.

Additionally, the audit results can be fed into the providers’ performance improvement process to improve charting and billing procedures. BHG employs experienced, professional auditors with advanced degrees who are independently licensed and certified to conduct Medical Necessity audits.

The benefit of having BHG conduct these audits is that they can be standardized for the BHG provider network and administered by one entity, thus eliminating variability, duplication and inefficiency. The audit results can then be aggregated and used for data analysis and benchmarking.

To learn more about how BHG can assist your board or agency please complete our information request form.