42 CFR § 456.23 - Post-payment review process.

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§ 456.23 Post-payment review process.

The agency must have a post-payment review process that -

(a) Allows State personnel to develop and review -

(1)Beneficiary utilization profiles;

(2) Provider service profiles; and

(3)Exceptions criteria; and

(b) Identifies exceptions so that the agency can correct misutilization practices of beneficiaries and providers.