Members have contacted the WVDA seeking further direction related to the Skygen/MCO audit findings.
Background:
- Skygen performed audits that included SDF overpayment determinations
- Medicaid invalidated the findings specifically about SDF due to a lack of policy support
- Medicaid directed MCOs NOT to pursue recoveries related to SDF
What next?
- Make sure you contact Dr. Diane Paletta, Skygen’s dentist representative at diane.paletta@skygenusa.com and let her know of your audit findings.
- Audited dentists must address the additional findings for items such as missing treatment plans, missing diagnoses, or a lack of documentation showing medical necessity.
- Dentists can simultaneously appeal through the MCO process and make a payment.
- If your appeal is denied by the MCO, you can further appeal to the Medicaid Office of Program Integrity to determine if the MCO followed all the correct steps and if they have documentation that substantiates the audit.
- Those appeals can be sent to Andrew Pack at Andrew.C.Pack@wv.gov, but only after the MCO appeal is denied.
