Virginia Medicaid:  Behavioral Health Provider Audits & Clinical Reviews

The Department of Medical Assistance Services (DMAS) has contracted with HMS to perform audits/clinical record reviews of Community Mental Health Rehabilitative Services and other Behavioral Health Services. Specifically, HMS is auditing and clinical record reviews for the following participating provider services: Crisis Intervention, Crisis Stabilization, Intensive Community Treatment, Intensive In-Home Services, Mental Health Case Management, Mental Health Skill-Building Services, Psychosocial Rehabilitation, Therapeutic Day Treatment, and Addiction and Recovery Treatment Services.

HMS and DMAS work together to ensure that Virginia Medicaid recipients receive appropriate behavioral and community mental health services in the appropriate setting. HMS also ensures that services received by Virginia Medicaid recipients are performed in accordance with standard practices, federal and state guidelines, and Medicaid policy guidelines.

Click here for the following information:

• Audit Review Process
• Authorized DMAS Auditor Contractor
• HMS Contact Information
• Findings Report Example
• How to Request an Appeal
• How to Submit Payment to DMAS Fiscal Division
• Links to DMAS Policy & Federal Regulations

Contact Information

Questions or inquiries regarding the Virginia Behavioral Health Provider Audits and Clinical Reviews can be sent to:

Kathryn Simpson, RN

Project Manager

Email: VABH@hms.com