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.
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.