The Medicaid Fee-For-Service Provider Payment Process

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November 2011

This issue brief provides an overview of the typical Medicaid provider claims submission and payment process, as well as additional non-claims-based payment processes, under fee for service (FFS) arrangements.  It also briefly describes post-payment review processes and the use of payment data for administrative purposes including program analysis and program integrity. Since the majority (79 percent) of total Medicaid benefit spending in fiscal year (FY) 2008 was attributable to FFS programs, this issue brief focuses on FFS payment. However, payment for services under managed care is also briefly addressed.

Publication Type: Issue Briefs

Tags: certified public expenditures (CPEs), cost sharing, fee for service, fee schedules, hospitals, Medicare, payment, physicians, supplemental payments