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June 2025 Top of Mind

Updated audit tools now available

The next time Optum Behavioral Health* conducts routine on-site and desktop (remote) audits of member records and your practice processes, you’ll have some handy tools to prepare ahead of time. Revised audit tools for adult and children under 21 are now available on Provider Express New York > Medicaid Provider Resources  > Quality Improvement  > NY Medicaid Audit Tools. Review them before your next audit so it goes off without a hitch. Check them out:

Adult only

Children under 21 only

Both adult and children under 21

Audits are conducted for many reasons: 

  • Ensure compliance with a state's regulations and Medicaid requirements
  • Verify that patient records accurately reflect services provided to them
  • Address specific quality of care issues or member concerns 
  • Check coordination of care activities 

Optum is required to conduct routine ongoing monitoring audits, which may occur annually, of in-network New York Health and Recovery Plan and Mainstream Medicaid care providers via desktop (remote) or onsite. Other audit types that may occur for New York in-network behavioral health providers include:

  • Quality of care concerns
  • Complaints
  • Critical incidents
  • Initial and recredentialing of unaccredited organizational providers

Providers are expected to maintain adequate medical records on all members and document all services provided. The audit process also confirms that services were provided to members. 

 Resources

See the provider Network Manual to review treatment documentation requirements (pages 53-57). You can also review UnitedHealthCare Community Plan Manual (scroll to New York, pages 60-78, chapter 7).

 Questions? 

Please call Provider Services at 1-877-614-0484.

 

 

*Optum Behavioral Health is responsible for managing the behavioral health and substance abuse benefits for UnitedHealthcare Community Plan members. 


 

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