Idaho Admin. Code r. 16.03.09.912
Current through September 2, 2024
The Department will review participants to determine if services are being utilized at a frequency or amount that results in a level of utilization or a pattern of services that is not medically necessary. Evaluation of utilization patterns can include review by the Department staff of medical records or computerized reports, or both, generated by the Department reflecting claims submitted for physician visits, drugs/prescriptions, outpatient and emergency room visits, lab or diagnostic procedures, or both, hospital admissions, and referrals.
Idaho Admin. Code r. 16.03.09.912