42 CFR 455.508 - Eligibility requirements for Medicaid RACs.
(a) The entity must demonstrate to a State that it has the technical capability to carry out the activities described in § 455.506 of this subpart. Evaluation of technical capability must include the employment of trained medical professionals, as defined by the State, who are in good standing with the relevant State licensing authorities, where applicable, to review Medicaid claims.
(b) The entity must hire a minimum of 1.0 FTE Contractor Medical Director who is a Doctor of Medicine or Doctor of Osteopathy in good standing with the relevant State licensing authorities and has relevant work and educational experience. A State may seek to be excepted, in accordance with § 455.516, from requiring its RAC to hire a minimum of 1.0 FTE Contractor Medical Director by submitting to CMS a written request for CMS review and approval.
(d) The entity must work with the State to develop an education and outreach program, which includes notification to providers of audit policies and protocols.
(e) The entity must provide minimum customer service measures including:
(1) Providing a toll-free customer service telephone number in all correspondence sent to providers and staffing the toll-free number during normal business hours from 8:00 a.m. to 4:30 p.m. in the applicable time zone.
(2) Compiling and maintaining provider approved addresses and points of contact.
(3) Mandatory acceptance of provider submissions of electronic medical records on CD/DVD or via facsimile at the providers' request.
(4) Notifying providers of overpayment findings within 60 calendar days.
(i) The entity meets other requirements as the State may require.