Professional Case Review Services
Masspro contracts with the Office of Medicaid to conduct professional case review services (PCRS). Within this type of review, health care providers are assessed for delivery of care across their clinical practice to ensure appropriate access and billing. The review also explores whether the quality of care provided to MassHealth members meets acceptable health care standards. Registered nurses perform the initial review, and identify areas of concern for the peer to evaluate.
Initial Notices of Determination are sent to the provider along with appeal rights.
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