Overview
- State officials say only claims flagged by analytics will be held for review and payments will still comply with the federal 90‑day requirement.
- The one‑year contract with Optum is valued at $2.3 million to analyze fee‑for‑service claims and identify irregularities before funds are released.
- The high‑risk list includes autism EIDBI, Integrated Community Supports, Nonemergency Medical Transportation and Housing Stabilization Services.
- Providers and families fear cash‑flow strains and service disruptions, and DHS issued follow‑up guidance after initial announcements caused confusion.
- Flagged claims will be reviewed by DHS and referred to the department’s Office of Inspector General as needed, with added safeguards such as fingerprint background checks and unannounced site visits.