---
kind: "section"
citation: "42 C.F.R. § 431.830"
title: "42"
number: "431.830"
heading: "Basic elements of the Medicaid quality control (MQC) claims processing assessment system."
url: "https://uscodex.org/cfr/42/431.830"
---

# §431.830. Basic elements of the Medicaid quality control (MQC) claims processing assessment system.


An agency must—

- (a) Operate the MQC claims processing assessment system in accordance with the policies, sampling methodology, review procedures, reporting forms, requirements, and other instructions established by CMS.
- (b) **Identify deficiencies in the claims processing operations.**
- (c) Measure cost of deficiencies;
- (d) Provide data to determine appropriate corrective action;
- (e) Provide an assessment of the State's claims processing or that of its fiscal agent;
- (f) Provide for a claim-by-claim review where justifiable by data; and
- (g) **Produce an audit trail that can be reviewed by CMS or an outside auditor.**

## Notes

### Source

Source: Sections 431.830 through 431.836 appear at 55 FR 22170, May 31, 1990, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 43 FR 45188, Sept. 29, 1978, unless otherwise noted.