Common use of Operational Audit Clause in Contracts

Operational Audit. We will develop a questionnaire through review of the Plan/TPA contract and conversations with the specific task order customers to zero in on areas of particular importance or concern. We will request policies and procedures surrounding enrollment, claims processing; appeals; employee training; fraud, waste, and abuse; internal audit; data security; HIPAA; and other areas of particular importance or concern as identified through the questionnaire development. Lastly, we will ensure Plan compliance with performance guarantees through detailed supporting documentation.