10A NCAC 22F .0705. OVERUTILIZATION SURVEILLANCE (SUR INDICATOR)

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(a) When a recipient overutilizes the Medicaid Program in specific instances, e.g., use of the emergency room, he shall be given an eligibility card indicating that he is an overutilizer, and warning providers to exercise caution in providing treatment to the recipient.

(b) The utilization pattern of a recipient will be reviewed periodically to determine if changes have occurred. If the overutilization pattern has been corrected the utilization surveillance will be ended and the recipient will receive an eligibility card without the SUR Indicator.

History Note: Authority G.S. 108A‑25(b); 108A‑64; 42 C.F.R. Part 431; 42 C.F.R. Part 455;

42 C.F.R. Part 456;

Eff. May 1, 1984.

                    
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