EPSDT Audit Sample Clauses

EPSDT Audit. In conjunction with the medical audit, complete EPSDT claims data for the Contractor and a sample of medical records will be evaluated by the Division to determine compliance by the Contractor with the requirements of this Contract for provision of EPSDT Services to Enrollees under age twenty-one (21). The Contractor must achieve a screening rate of eighty-five percent (85%) and an immunization rate of ninety percent (90%) in order to be in compliance with this contract. For a child who has been enrolled from birth through 12 months, compliance with the EPSDT periodicity schedule is six (6) screens. Immunization compliance means that the child is up to date with his/her immunizations based on the ACIP immunization schedule. The Contractor shall bear no refund obligation related to this section during the initial contract period. For all renewal periods following the initial contract period, failure to achieve the above screening rate shall require the Contractor to refund to the Division the following amount: • Achievement of <85% screening and 90% immunization rate (the lowest rate shall be considered to be the rate for both screenings and immunizations) will require a refund of $10 per Enrollee for all Enrollees under age 12 mos. • The Division will publish the achievement of screening rates of eighty-five percent (85%) or greater to the Medicaid population and the medical community in the applicable service area. The Division will require its Contractor to make all screening rates known to potential enrollees in required educational and marketing presentations.
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EPSDT Audit. In conjunction with the medical audit, complete EPSDT claims data for the Contractor and a sample of medical records will be evaluated by the Division to determine compliance by the Contractor with the requirements of this Contract for provision of EPSDT Services to Enrollees under age twenty-one (21). The Contractor must achieve a screening rate of eighty-five percent (85%) and an immunization rate of ninety percent (90%) in order to be in compliance with this contract. This percent will be from the reported EPST 416 report and will use the reportable number for Line 7-Screening Ratio-divide the actual number of initial and periodic screening services received (line 6 of 416 report) by the expected number of initial and periodic screening services (line 5 of 416 report). This ratio indicates the extent to which EPSDT eligible receive the number of initial and periodic screening services required by the State’s periodicity schedule prorated by the portion of the year for which they are Medicaid eligible. For a child who has been enrolled from birth through 12 months, compliance with the EPSDT periodicity schedule is six (6) screens. Immunization compliance means that the child is up to date with his/her immunizations based on the ACIP immunization schedule. The Contractor shall bear no refund obligation related to this section during the initial contract period. For all renewal periods following the initial contract period, failure to achieve the above screening rate shall require the Contractor to refund to the Division the following amount:  Achievement of <85% screening and 90% immunization rate (the lowest rate shall be considered to be the rate for both screenings and immunizations) based on the screening ratio calculation will require a refund of $100 per Enrollee for all Enrollees under age 12 mos.  The Division will publish the achievement of screening rates of eighty-five percent (85%) or greater to the Medicaid population and the medical community in the applicable service area. The Division will require its Contractor to make all screening rates known to potential enrollees in required educational and marketing presentations.
Sample 1

Related to EPSDT Audit

  • SAO AUDIT A. The state auditor may conduct an audit or investigation of any entity receiving funds from the state directly under the Contract or indirectly through a subcontract under the Contract. The acceptance of funds directly under the Contract or indirectly through a subcontract under the Contract acts as acceptance of the authority of the state auditor, under the direction of the legislative audit committee, to conduct an audit or investigation in connection with those funds. Under the direction of the legislative audit committee, an entity that is the subject of an audit or investigation by the state auditor must provide the state auditor with access to any information the state auditor considers relevant to the investigation or audit.

  • Payment Audit Records of costs incurred under terms of the Contract will be maintained in accordance with section 8.3 of these Special Contract Conditions. Records of costs incurred will include the Contractor’s general accounting records, together with supporting documents and records of the Contractor and all subcontractors performing work, and all other records of the Contractor and subcontractors considered necessary by the Department, the State of Florida’s Chief Financial Officer, or the Office of the Auditor General.

  • Customer Audit Customer or its independent third party auditor reasonably acceptable to SAP (which shall not include any third party auditors who are either a competitor of SAP or not suitably qualified or independent) may audit SAP’s control environment and security practices relevant to Personal Data processed by SAP only if:

  • Contract Audits Eligible Purchaser represents and warrants that it shall cooperate with Enterprise Services, the Office of the State Auditor, federal officials, and/or any third party authorized by law or contract, in any audit conducted by such party pertaining to any Contracts that Eligible Purchaser has made purchases from pursuant to this Agreement, including providing records related to any purchases from such Contracts.

  • Independent Audit The Grantee shall submit, in a format specified by the department, the independent financial compliance audit prepared by an independent Certified Public Accountant for the previous fiscal year. The audit shall follow the General Grant Requirements of Sections VIII (F) and (G) and be submitted no later than March 1 of the current fiscal year.

  • Inspection & Audit Contractor agrees that the relevant books, records (written, electronic, computer related or otherwise), including, without limitation, relevant accounting procedures and practices of Contractor or its subcontractors, financial statements and supporting documentation, and documentation related to the work product shall be subject, at any reasonable time, to inspection, examination, review, audit, and copying at any office or location of Contractor where such records may be found, with or without notice by the City, and with regard to any federal funding, the relevant federal agency, the Comptroller General, the General Accounting Office, the Office of the Inspector General, or any of their authorized representatives. All subcontracts shall reflect the requirements of this paragraph.

  • Auditor Report; Right to Audit (a) Within the time period permitted for the examination audit pursuant to 12 CFR Section 363 after the end of each fiscal year during which the Receiver makes any payment to the Assuming Institution under this Single Family Shared-Loss Agreement, the Assuming Institution shall deliver to the Receiver a report signed by its independent public accountants stating that they have reviewed the terms of this Single Family Shared-Loss Agreement and that, in the course of their annual audit of the Assuming Institution’s books and records, nothing has come to their attention suggesting that any computations required to be made by the Assuming Institution during such fiscal year pursuant to this Article II were not made by the Assuming Institution in accordance herewith. In the event that the Assuming Institution cannot comply with the preceding sentence, it shall promptly submit to the Receiver corrected computations together with a report signed by its independent public accountants stating that, after giving effect to such corrected computations, nothing has come to their attention suggesting that any computations required to be made by the Assuming Institution during such year pursuant to this Article II were not made by the Assuming Institution in accordance herewith. In such event, the Assuming Institution and the Receiver shall make all such accounting adjustments and payments as may be necessary to give effect to each correction reflected in such corrected computations, retroactive to the date on which the corresponding incorrect computation was made.

  • Final Audit Pursuant to section 1002.33, Florida Statutes, upon notice of non- renewal, closure, or termination, an independent audit shall be completed within 30 days to account for all public funds and assets. During the fiscal year in which the termination or non-renewal occurs, the Sponsor may withhold from the School's FEFP funds, without penalty or interest, an amount necessary to cover the costs for a final financial audit of the School. The audit shall be conducted by an independent certified public accountant.

  • Independent Auditor The Company’s independent auditor, if any, shall be an independent public accounting firm selected by the Member, which may also be the Member’s independent auditor.

  • Records; Audit During the Royalty Term and for five (5) years thereafter, OST shall keep, and shall cause its Affiliates and Sublicensees to keep, complete and accurate records pertaining to the sale or other disposition of Licensed Product in sufficient detail to permit Advaxis to confirm the accuracy of payments due hereunder. Advaxis shall have the right, upon thirty (30) days’ prior written notice to OST, to cause an independent, certified international public accounting firm reasonably acceptable to OST to audit such records during OST’s normal business hours with the purpose of confirming the number of Licensed Product units sold, the gross sales and Net Sales of Licensed Product, the royalties payable, the method used to calculate the royalties payable, and the exchange rates used in accordance with Section 7.2. An audit under this Section 7.4 shall not occur more than once in any Calendar Year, except in the case of any subsequent “for cause” audit. The accounting firm shall disclose to Advaxis only whether the reports are correct or incorrect and the specific details concerning any discrepancies. No other information shall be provided to Advaxis. The accounting firm shall provide OST with a copy of any disclosures or reports made to Advaxis and OST shall have an opportunity to discuss such disclosures or reports with Advaxis and the accounting firm. Information, disclosures, or reports arising from any such examination shall be Confidential Information of OST subject to the confidentiality and other obligations of Article 10. Prompt adjustments shall be made by the parties to reflect the results of such audit (but in no event later than forty-five (45) days thereafter). Advaxis shall bear the full cost of such audit unless such audit discloses a variance of more than the greater of (x) ten percent (10%) of the payments due under this Agreement or (y) One Million US Dollars ($1,000,000), in which case, OST shall bear the full cost of such audit.

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