MES Certification Navigator
PI1

CMS-Required Outcome

CMS-required outcome

System can check member record to ensure the member on the claim was enrolled in the Medicaid program and the benefit was covered at the time of service. Membership enrollment records the system is checking against are updated daily. *Applicable to CP

Default metrics
  • Count of claims with a non-member/total claims submitted (Target=0%)
Regulatory sources
  • None cited

Other Program Integrity outcomes