[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-281023-105":53,"doc-detail-281023-en":126},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":119,"head_meta":121,"extra_data":123,"updated_unix":125},105,"en","ahcccs-hms-provider-faq-v2-recovery-audit-contractor-rac-program","AHCCCS HMS Provider FAQ V2 - Recovery Audit Contractor (RAC) Program","","Provider FAQs explain the Arizona (AHCCCS) Medicaid Recovery Audit Contractor (RAC) program established to reduce improper payments by detecting and collecting overpayments, identifying underpayments, and preventing future improper payments. The FAQs cover the contracted vendor, Health Management Systems (HMS), review timeframes (including a five-year lookback), automated versus complex reviews, provider notices, claim selection, limits for complex requests, documentation submission options, and response deadlines with consequences for noncompliance.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/ahcccs-hms-provider-faq-v2-recovery-audit-contractor-rac-program/281023/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/ahcccs-hms-provider-faq-v2-recovery-audit-contractor-rac-program/281023.png","ImageObject",442,249,{"name":88,"@type":89},"Cipher","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-27","2026-09-16",true,{"@type":98,"interactionType":99,"userInteractionCount":25},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What is the Recovery Audit Contractor (RAC) program for AHCCCS Medicaid?","Question",{"text":108,"@type":109},"Under Section 6411(a) of the Affordable Care Act, each state contracts with a vendor to review provider claims. The goal is to reduce improper payments by detecting and collecting overpayments, identifying underpayments, and preventing future improper payments.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"Who is contracted to act as the RAC for Arizona Medicaid, and how far back can reviews go?",{"text":113,"@type":109},"Health Management Systems (HMS), a Gainwell Technologies company, is contracted as Arizona’s RAC. The lookback period is defined as five (5) years from the claim date of service.",{"name":115,"@type":106,"acceptedAnswer":116},"How do providers respond to complex review medical record requests, and what are the consequences of missing deadlines?",{"text":117,"@type":109},"For complex reviews, providers have thirty (30) calendar days from the date of the Medical Record Request Letter to submit documentation. If records are not submitted within the initial window, an additional thirty (30) calendar days may be granted after a Follow-Up request; after that, providers receive a Technical Denial Letter, and failure to remit can result in recoupment of the paid claim by AHCCCS.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},281023,1790182671,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":25,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":73},687208528416,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","1. What is the Recovery Audit Contractor (RAC) program?  \nUnder Section 6411(a) of the Affordable Care Act, each state must contract with a vendor to review provider claims. The purpose of the review is to reduce improper payments for the Arizona (AHCCCS) Medicaid program through the detection and collection of overpayments, the identification of underpayments and the implementation of actions that will prevent future improper payments.  \n2. Who does AZ Medicaid contract with for the RAC program?  \nHealth Management Systems (HMS), a Gainwell Technologies company, has been contracted to act as the Recovery Audit Contractor for Arizona.  \n3. Does RAC only review current claims?  \nRAC reviews may be conducted for current claims as well as those that fall within Arizona’s allowable RAC program “lookback” period.  \n4. How far back can the RAC go in reviewing claims?  \nThe lookback period is defined as five (5) years from claim date of service (from date). The lookback period applies to requests for medical records for complex reviews or notification of findings for automated reviews.  \n5. How are RAC reviews conducted?  \nHMS utilizes two types of reviews for the RAC program. These are automated reviews and complex reviews.  \n6. What is an automated review?  \nAutomated reviews are conducted by HMS using data mining algorithms to identify overpayment of claims paid by AHCCCS. An automated review can occur when potential overpayments are identified from claim data elements. The data from the claims is weighed against well-established policies and rules. The automated review does not require the examination of medical records or other documents.  \n7. What is a complex review?  \nA complex review requires human intervention for the review to be completed. Unlike an automated review, a complex review requires a manual review of medical records or other documents to fully evaluate the validity of claims submitted.  \nWhen a complex review is initiated, a Medical Records Request Letter is sent to providers. The letter requests medical records and other relevant documentation needed to complete the review.  \n8. Will the RAC be conducting automated reviews and if so, will providers receive notice that their claims are being audited?  \nThe RAC will conduct ongoing automated reviews of transactions that have been processed by AHCCCS. Providers will not be notified when claims are included in an automated review but will receive a notification if an overpayment is identified.  \n9. Will the RAC audit all the claims submitted by a facility?  \nThe RAC may look at any claims submitted by a facility.  \n10. Are there limitations to the number of claims which can be reviewed?  \nThere are no limitations to the number of claims which can be reviewed, however, under the complex clinical reviews AHCCCS has established limits for the number of medical records requested each month for each provider. These limits are reviewed and approved by AHCCCS.  \n11. Will the audits focus only on institutional providers?  \nNo. All Medicaid provider types will be subject to audit by the RAC program, including, but not limited to laboratories, individual providers such as physicians, therapists, durable medical equipment providers, long term care and home health providers.  \n12. How are claims selected for review?  \nAHCCCS and HMS collaborate to develop a scope for the review, including the type of claims to be reviewed, the applicable state and federal policies, claims payment system logic, etc. Once the scope is approved by AHCCCS, HMS’ algorithms are applied to claims data and claims are selected for review.  \n13. Can I submit records electronically?  \nYes. The Medical Records Request letter from HMS will provide information related to medical records submission, including submission methods and timelines. HMS accepts provider submissions via Secure File Transfer Protocol (SFTP) or via HMS Provider Portal.  \n14. How do I sign up to use the HMS Provider Portal?  \nPlease v","cbCaigsepymw0jFS","https://ap.wps.com/l/cbCaigsepymw0jFS","pdf",172867,"English","# Recovery Audit Contractor (RAC) program overview\n# RAC contract, review scope, and lookback period\n# Types of RAC reviews: automated vs. complex\n# Notices, claim selection, and review limitations\n# Medical records requests: submission methods and deadlines","[{\"question\":\"What is the Recovery Audit Contractor (RAC) program for AHCCCS Medicaid?\",\"answer\":\"Under Section 6411(a) of the Affordable Care Act, each state contracts with a vendor to review provider claims. The goal is to reduce improper payments by detecting and collecting overpayments, identifying underpayments, and preventing future improper payments.\"},{\"question\":\"Who is contracted to act as the RAC for Arizona Medicaid, and how far back can reviews go?\",\"answer\":\"Health Management Systems (HMS), a Gainwell Technologies company, is contracted as Arizona’s RAC. The lookback period is defined as five (5) years from the claim date of service.\"},{\"question\":\"How do providers respond to complex review medical record requests, and what are the consequences of missing deadlines?\",\"answer\":\"For complex reviews, providers have thirty (30) calendar days from the date of the Medical Record Request Letter to submit documentation. If records are not submitted within the initial window, an additional thirty (30) calendar days may be granted after a Follow-Up request; after that, providers receive a Technical Denial Letter, and failure to remit can result in recoupment of the paid claim by AHCCCS.\"}]","AHCCCS HMS Provider FAQ V2 - Recovery Audit Contractor (RAC) Program | PDF",1789563610]