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HealthChoices Audit Examination Guide

The HealthChoices Examination Guide (Guide) helps independent public accountants understand the HealthChoices Behavioral and Physical Health Program examination criteria established by the PA Department of Human Services (DHS). Compliance requirements of the Guide are divided into four parts:

  • Claims processing
  • Management information system encounter data reporting
  • Health services delivery system and administrative services organization incentive arrangements
  • Financial management
The current Guide includes recent changes to the HealthChoices Program.  DHS also publishes financial reporting and claims processing requirements for both the Behavioral and Physical Health Programs. 

The Guide and supplemental schedules and reports provide the minimum procedures an independent public accountant should perform and are not intended to be all-inclusive. The accountant must determine the nature, timing, and extent of the procedures to be performed based on the accountant’s professional judgment.

The Bureau of Audits is responsible for issuing the Guide. Please direct questions about the Guide or the supplemental schedules and reports to