The terms of the Medicaid Managed Care/Family Health Plus/HIV Special Needs Plan/Health and Recovery Plan Model Contract, section 18.5(a)(viii)(F), require Managed Care Organizations (MCOs) to submit a Provider Investigative Report to the Office of the Medicaid Inspector General (OMIG) and the Department of Health (DOH) monthly.
The Provider Investigative Report informs OMIG and DOH of any Medicaid provider investigative, educational, or re-educational activities performed by the MCO or its subcontractors, including all overpayments recovered. In addition to reporting investigative activities, the MCO must also upload copies of all Medicaid-related settlement agreements.
This guidance has been updated and is current with the terms of the March 1, 2019, as amended March 1, 2020, and April 1, 2021, Medicaid Managed Care/Family Health Plus/HIV Special Needs/Health and Recovery Plan Model Contract and subsequent agreements.
Provider Investigative Report Submission Schedule
The Provider Investigative Report must be completed and submitted monthly. Each monthly report is due in accordance with the following submission schedule. Note: When the due date falls on a non-business day, the report is due on the following business day.
For the Report Period (2025) | Report Submission Due Date | ||||||
January | February 28 | ||||||
February | March 31 | ||||||
March | April 30 | ||||||
April | May 31 | ||||||
May | June 30 | ||||||
June | July 31 | ||||||
July | September 2 | ||||||
August | September 30 | ||||||
September | October 31 | ||||||
October | December 1 | ||||||
November | January 2 | ||||||
December | January 30 |