PM11
Risk Level Assignment
Also listed under Program Integrity.
CMS-required outcome
A state user can assign and screen all applications by a risk categorization of limited, moderate, or high for a provider at the time of new application, re-enrollment, or re-validation of enrollment. A state user can adjust a provider's risk level due to payment suspension or moratorium.
Default metrics
- Number of providers in each category by category for each new application, re-enrollment/revalidation
- Number of providers with changes from moderate to high due to payment suspension or moratorium
Regulatory sources