Service Category 3 – Claims Auditing Tasks among others that the tasks that may be permissible for Service Category 3 include, but are not limited to: “Audit Customer information processed during the audit period” The services sought in this procurement are for statewide use by any eligible Customer. Customer information and the time period(s) will be defined by the Customer specific scope of work. The Department of Management Services Division of State Group Insurance has previously requested post payment audits of medical and pharmacy claims. Please provide a sample or further explanation of “Customer information” What time period(s) would be subject to “Audit”? The Department of Management Services has previously defined an audit period as July 1st through June 30th of a year.
Service Category 3 – Claims Auditing Tasks. Tasks that may be permissible for Service Category 3 include, but are not limited to: • Audit Customer information processed during audit period. • Operational assessment of administrative operations. • Evaluate compliance with statutory, regulatory, and contractual requirements. • Proactively search for potential fraud and abuse.
