Quality Assurance Division
"Improving the Lives of Others"
The mission of the Quality Assurance Division (QAD) is to promote and protect the health, safety, and well being of people in Montana by providing responsive, independent assessment and monitoring of human services, through respectful relationships.
The division fulfills this role by:
- Licensing and/or certifying health care, child care, and residential services;
- Detecting and investigating abuse and fraud committed by recipients of Temporary Assistance to Needy Families (TANF), Medicaid and Food Stamp programs;
- Monitoring recipient overpayment claims for TANF, Medicaid and SNAP;
- Performing federally mandated quality-control reviews of the Medicaid and Food Stamp programs;
- Reducing Medicaid costs by identifying other insurers or parties responsible for paying a beneficiary's medical expenses;
- Providing internal and independent audits for DPHHS programs;
- Conducting retrospective reviews of Medicaid provider claims;
- Determining medical necessity for prior authorization of medical services and requests for durable medical equipment;
- Providing independent fair hearings for clients and providers participating in DPHHS programs;
- Monitoring and evaluating Health Maintenance Organizations for quality assurance and network adequacy;
- Maintaining a certified nurse aide registry;
- Approving and monitoring nurse aide training programs;
- Operating the Certificate of Need program; and
- Ensuring department compliance with the federal Health Information Portability and Accountability Act (HIPAA).
The division has field offices in Anaconda, Billings, Bozeman, Great Falls, Havre, Hinsdale, Kalispell, Livingston, Miles City, and Missoula.
Anyone with concerns about the care provided by nursing homes and other long-term care facilities can also contact the Montana Long-term Care Ombudsman: (406) 444-4676 or (800) 332-2272.
Concerns regarding Medicaid fraud can be directed to:
- Recipient eligibility fraud, (800) 201-6308
- Recipient abuse (Team Care), (800) 362-8312
- Provider fraud, (800) 376-1115