Patient Volume Documentation Request

Please be prepared to provide a Patient Volume Listing for the 90-day patient volume period. During our pre-payment audit review process, we may find that the patient volume attestation is at risk in not meeting the 30% (or 20% for pediatricians) Medicaid patient volume threshold. If we cannot validate the patient volume amounts, we will contact the application preparer and request a Patient Volume Listing (preferably in an Excel spreadsheet format) for the 90-day period used to attest. Below is a description of the listing and the minimum required data fields.

  • Patient Volume Listing displays the 90-day patient volume encounters used to attest the provider’s individual or group patient volume amounts. This listing represents the numerator (Medicaid encounters) and denominator (all encounters) amounts used to determine whether the provider has met the 30% (or 20% for pediatricians) Medicaid patient volume threshold. This listing must at least include the following data elements for the related 90-day patient volume period attesting (i.e., January 1, 2013 to March 30, 2013):
    • Date of Service
    • Patient Full Name
    • Patient ID (can  be truncated to protect PHI)
    • Primary Insurance
    • Secondary Insurance

Note: Adding summary totals by Primary and Secondary Insurance may improve the prepayment review process time.