8.5 Purchasing Reviews


Purchasing reviews can occur during or after services have been provided and purchased.

The purpose is to ensure that:

  • a participant is receiving or has received services based on medical necessity;
  • the services occur or occurred in the frequency and duration specified in the Individualized Written Rehabilitation Plan and the treatment outcomes meet or met the participant’s needs; and
  • CRS program staff members are following billing requirements from CRS policies and procedures and providers are rendering services as determined by the CRS counselor and participant.

The review may include:

  • a review of the Individualized Program Plan and Individualized Written Rehabilitation Plan;
  • therapy assessments and therapy notes, along with treatment plans and treatment data;
  • review of medical necessity;
  • review of explanation of benefits or denials;
  • review of number of hours or days of service provided; and
  • review of documentation confirming all billing activities in accordance with CRS policy and standards.