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PROVIDER INITIATED SELF DISCLOSURE REPORT FORM Please complete and return this form along with your self audit refund check. If you choose to do on-line claims adjustments in lieu of sending a check or in conjunction with a check the adjustment information needs to be reported using this form. Please submit all documents or checks related to any self disclosure to MO HealthNet Division Attn Program Integrity Unit SELF DISCLOSURE P. You should also submit documentation explaining the reason...
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What is provider initiated self disclosure?
Provider initiated self disclosure is a process where healthcare providers voluntarily report and disclose any potential violations of healthcare rules and regulations to the appropriate authorities or agencies.
Who is required to file provider initiated self disclosure?
Healthcare providers, including hospitals, clinics, physicians, and other healthcare professionals, are required to file provider initiated self disclosure if they become aware of any potential violations.
How to fill out provider initiated self disclosure?
Filling out provider initiated self disclosure involves providing a detailed description of the potential violation, including all relevant facts and circumstances, as well as any corrective actions already taken or planned to avoid future violations.
What is the purpose of provider initiated self disclosure?
The purpose of provider initiated self disclosure is to promote transparency and integrity in the healthcare system by allowing providers to proactively address and rectify potential violations, ultimately preventing fraud, waste, and abuse.
What information must be reported on provider initiated self disclosure?
Provider initiated self disclosure must include a description of the potential violation, the parties involved, dates of occurrence, specific laws or regulations potentially violated, and any financial impact or damages.
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