Recovery Audit Contractor (RAC) Audit Information
Two automated RAC audits, “EMT Trips with No Corresponding Medical Claims and Professional Duplicates,” will occur in the next couple of weeks (November 2025). We will be starting these audits and our new RAC processes with a Pilot with a small number of providers. Once the RAC Pilot providers receive audit letters they will work closely with the Department and HMS to ensure the new processes are working as needed.
A DRG complex audit will tentatively roll out on a limited basis in December 2025 to all providers. There will not be a pilot for this DRG audit, as complex audits are focused on medical records requests for specific provider claims.
HMS has made a lot of updates and improvements to the HMS Provider Portal. We strongly encourage all providers to make sure they are registered with the HMS Provider Portal and review that their information in the portal is up to date. Please be aware the HMS Provider Portal is different from the Provider InterChange Portal.
The RAC team is committed to working closely with all providers in streamlining the process and eliminating waste. We appreciate your participation and feedback!