Review the current contract language and determine if there is a need to clarify thethird-party administrators claims adjudication responsibilities in its contracts to includethe identification of unauthorized dental procedures and adjudication of possible denials of payment or implement controls within VA that will perform this adjudication function for dental claims.
Questioned Costs
$0
Funds for Better Use
$0
Recommendation Status
Open
Source UUID
23-00749-171-04
Recommendation Number
04
Significant Recommendation
No