AUDIT REVIEW AND PREPARATION CHECKLIST

SUBSTANCE ABUSE REHABILITATIVE SERVICES AUDIT CHECKLIST Beneficiary’s Name ___________________________________________ Beneficiary’s Medicaid # _________________________DOB_________________ Service Dates FROM: ___________________TO _____________________ Provider Name _______________________Provider Medicaid ID # _____________ Provider Contact Person/ph/email: ________________________________________ Itemized below is documentation that is related to the type of services provided by a Substance Abuse Rehabilitative Service center. The requested documentation depends upon the nature of the service rendered. Outpatient and Intermediate Care Facilities 1. Admission/Face sheet that has beneficiary’s name, DOB, and other identifying information 2. A comprehensive intake assessment that establishes the need for treatment, and if billing for skills development that the assessment identifies the need for this service 3. Assessment for Methadone clients must include a copy of the medical screening 4. Treatment plan must contain primary/secondary diagnoses, problem list, treatment objectives, services, frequency and expected duration of treatment 5. Treatust be dated and contain all required signatures within 30 days of initial treatment (for outpatient treatment) and 7 days (for residential treatment 6. Treatment plan reviews are conducted (when required) within appropriate timeframes 7. Progress notes are included in documentation and must ...