Staff in the Surveillance and Utilization Review Unit (SURS) monitor financial claims for NH's Medicaid plan. SURS reviews all provider claims for fraud, waste or abuse. The unit also recovers overpayments. If there appears to be a case of fraud, it is referred to the Attorney General's office for further review. SURS also conducts reviews to determine if recipients are inappropriately using certain types of medications.
SURS provides management of the Quality Improvement Organization (QIO) contract, which is responsible for the review of all hospital admissions for medical necessity and quality of care.
Specifics activities include:
- On-site audits and desk reviews of provider bills and medical records;
- Monitor the Quality Inpatient Organization Contract for in-patient claims;
- Review of pended provider claims;
- Verification of recipient medical services;
- Monitor provider sanctions received by Medical Boards;
- Make recommendations for claims processing system modifications;
- Assess and report on program outcomes and recommend policy and procedure changes as necessary; and
- Review of new provider enrollment applications as necessary.