42 CFR 431.830
§ 431.830 Basic elements of the Medicaid quality control (MQC) claims processing assessment system.
United States · 42 CFR — Public Health · Status: effective
Cite this
- Citation
- 42 CFR 431.830, § 431.830 Basic elements of the Medicaid quality control (MQC) claims processing assessment system, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/205686
- Permanent ID
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Full text
An agency must—
(a) Operate the MQC claims processing assessment system in accordance with the policies, sampling methodology, review procedures, reporting forms, requirements, and other instructions established by CMS.
(b) Identify deficiencies in the claims processing operations.
(c) Measure cost of deficiencies;
(d) Provide data to determine appropriate corrective action;
(e) Provide an assessment of the State's claims processing or that of its fiscal agent;
(f) Provide for a claim-by-claim review where justifiable by data; and
(g) Produce an audit trail that can be reviewed by CMS or an outside auditor.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.