AR-. 40 The Contractor shall give the Department full access rights to perform audits, or have audits performed by a third party, as determined necessary or required to ensure and validate that premiums are being expended timely, efficiently and within compliance of all governing Florida Statutes and the Contract. The Department’s audit rights are further specified in the Contract. AR-41 The Contractor shall make a designated, internal audit representative available to the Department or its designee throughout the entire audit process. AR-42 The Contractor shall research discrepancies identified during the audit and report the results within ten (10) Business Days of the identification of the discrepancies. AR-43 The Contractor shall review draft audit reports provided by the Department or its designee and provide written responses within ten (10) Business Days of receipt. The Contractor's response will be included in final report. AR-44 The Contractor shall provide one (1) unredacted response to the audit and one (1) redacted response to the audit in the event confidential or proprietary information is contained within the report. Only confidential or proprietary information should be redacted. AR-45 The Contractor shall provide a CAP to address all audit findings in the manner and timeframe designated by the Department. All audit findings are to be completely remediated (system corrections, financial impact analyses and reimbursement – where applicable) within sixty (60) Calendar Days of the issuance of the audit report. AR-46 The Contractor shall reimburse impacted Participants for any financial findings identified during the audit within twenty (20) days of written notification from the Department as to the final amount due. AR-47 The Contractor shall perform, no less frequently than quarterly, internal audits on a statistically valid sample of claims and shall provide results to the Department via Quarterly Reports. At a minimum, the quarterly audits must provide the Department with sufficient information to apply the measurement methodologies of PG-16 and PG-17 of Attachment 3: Performance Guarantees, of the Draft Contract.
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Sources: Group Dental Insurance Contract, Group Dental Insurance Contract, Group Dental Insurance Contract