NAMPI Member Portal | Scott Best | Activity https://staging.member.nampi.net/members/scott-besthca-wa-gov/activity/ Activity feed for Scott Best. Mon, 20 Oct 2025 17:54:03 -0400 https://buddypress.org/?v=2.9.30 en-US 30 hourly 2 32cbcb799e78d502ae18707d070fe733 Scott Best replied to the discussion MFCU Questions in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/mfcu-questions-2/#post-2065 Wed, 26 Apr 2023 16:03:22 -0400 Reply to MFCU Questions

Here is our Managed Care Fraud Referral Form.

]]> e5a213dabd6e78021e53427876e8a256 Scott Best replied to the discussion MFCU Questions in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/mfcu-questions-2/#post-2063 Wed, 26 Apr 2023 16:02:12 -0400 Reply to MFCU Questions

Here is our Fraud Referral Form.

]]> b861f9ba1605f40f934c5f9b3407d4be Scott Best replied to the discussion MFCU Questions in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/mfcu-questions-2/#post-2061 Wed, 26 Apr 2023 15:51:16 -0400 Reply to MFCU Questions

Washington PI does not meet with MFCU before we submit a referral. We send a form with any supporting information as soon as it is determined to be Fraud. We meet with our MFCU counterparts every month for a deconfliction meeting. When we refer a case to MFCU they are marked in our case management as being “with MFCU”. They are not closed but…

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]]> 5e89c8ce4af93d687b7c5bf1764028c2 Scott Best replied to the discussion Request for Assistance - Bringing PI fraud analytics in-house in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/request-for-assistance-bringing-pi-fraud-analytics-in-house/#post-2035 Tue, 18 Apr 2023 17:03:08 -0400 Reply to Request for Assistance - Bringing PI fraud analytics in-house

Here is a comparison of all procedure codes. this requires Counts_By_procedure_By_CY_STEP_1.sql to be run first.

]]> d7fe322f5f64118ecb716d544370b5e4 Scott Best replied to the discussion Request for Assistance - Bringing PI fraud analytics in-house in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/request-for-assistance-bringing-pi-fraud-analytics-in-house/#post-2033 Tue, 18 Apr 2023 17:01:00 -0400 Reply to Request for Assistance - Bringing PI fraud analytics in-house

Another analysis I think is really interesting is comparing procedure codes over time to see what is on the rise. The first step is to get counts of providers claims and cost by calendar year then you can do all kinds of analysis like which procedures are increasing and costing more.

]]> 04d88689eca6c6ded7edec2a33756a9b Scott Best replied to the discussion Request for Assistance - Bringing PI fraud analytics in-house in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/request-for-assistance-bringing-pi-fraud-analytics-in-house/#post-2031 Tue, 18 Apr 2023 16:53:33 -0400 Reply to Request for Assistance - Bringing PI fraud analytics in-house

Compare prescribers.

]]> 36e1d5ddf5ff7c9ae0b39692ecd7d3f2 Scott Best replied to the discussion Request for Assistance - Bringing PI fraud analytics in-house in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/request-for-assistance-bringing-pi-fraud-analytics-in-house/#post-2029 Tue, 18 Apr 2023 16:51:09 -0400 Reply to Request for Assistance - Bringing PI fraud analytics in-house

Billers use of Procedure codes

]]> bcaf6bf9bcf4313fda9e0ba68cf7bd72 Scott Best replied to the discussion Request for Assistance - Bringing PI fraud analytics in-house in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/request-for-assistance-bringing-pi-fraud-analytics-in-house/#post-2027 Tue, 18 Apr 2023 16:49:57 -0400 Reply to Request for Assistance - Bringing PI fraud analytics in-house

We have been without a Fraud and Abuse Detection System for quite some time. During that time, I developed a few really handy analyses. My favorite analysis compared servicing Providers, billing Providers, or prescribing providers use of procedure codes against all providers with the same taxonomy and reports those by year that are billing…

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]]> b2067914091ccd207a120a1ebb543fe4 Scott Best replied to the discussion States who have or are seeking an exception to the Medicaid RAC requirement in the forum State Only Forum https://staging.member.nampi.net/nampi-member-forums/discussion/states-who-have-or-are-seeking-an-exception-to-the-medicaid-rac-requirement/#post-1959 Tue, 14 Mar 2023 19:45:42 -0400 Reply to States who have or are seeking an exception to the Medicaid RAC requirement

WA currently has a waiver

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