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Audit Timeline

How long does an audit or review take?

Audit Timeline: 

Draft Report/Preliminary Clinical Review Notice Timeline: 
The average time from the onsite visit or formal request for records to issuance of the draft audit report or preliminary clinical review notice is three months 
 
Informal Dispute Timeline: 
If a provider disputes any draft or preliminary clinical review findings, they normally have thirty  calendar days, although 60 days for some provider types, from the date the draft audit report or preliminary clinical review notice is received to notify the Division of Program Integrity of what they are disputing. § 1306.4 of Title 29 DCMR
 
Final Report/Clinical Overpayment Notice Timeline: 
On average, the final audit report/clinical overpayment notice is issued within three months following the dispute process. 
 
Appeals Timeline: 
If a provider appeals the overpayment; they have 15 days from the receipt date of the final audit report or overpayment notice to request an adjudicative proceeding, also known as an “administrative hearing.” § 1307.8 of Title 29 DCMR