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0 <br /> ATTACHMENT A <br /> 1. Scope of Services. Specific to this Agreement, Service Provider will provide the <br /> following Services for the City relative to medical claims administered by Healthcare <br /> Management("Administrator"). <br /> • Service Provider will contact Administrator to review audit process and data needs. <br /> • Service Provider will review the City enrollment records versus Administrator <br /> eligibility records for the audit period to confirm that only those truly eligible for the <br /> plan were covered. <br /> • Service Provider will review all pertinent plan design documents in order to <br /> customize its electronic auditing tools. <br /> • Service Provider will electronically audit 100% of medical claims paid by <br /> Administrator from January 1, 2014,through December 31, 2015. <br /> • Service Provider will produce exception reports identifying and organizing all claims <br /> potentially paid in error into error categories. <br /> • Upon review of all error categories, Service Provider will then judgmentally select up <br /> to 100 total claims that will provide the necessary information to support all claims <br /> within each error category. <br /> • Service Provider will then perform an on-site audit of those judgmentally selected <br /> claims at Administrator's claims payment location. Each on-site audited claim will <br /> be logged onto a worksheet detailing the reason for which Service Provider considers <br /> the claim was paid in error. <br /> • Administrator will be provided copies of all worksheets in order for them to reply to <br /> Service Provider's findings. Administrator will then return their responses back to <br /> Service Provider within a reasonable amount of time and all responses will be <br /> published in the Final Report. <br /> • Based upon the on-site findings and Administrator's responses, Service Provider will <br /> re-examine the full electronic file to determine if additional claims (those related by <br /> same patient and/or services) are to be included in the Final Report. <br /> • Service Provider will prepare and deliver the Final Report using detailed <br /> spreadsheets, narrative findings, and recommendations based on the electronic <br /> analysis, on-site audit reviews, and Administrator's responses. <br /> Page 7 <br /> 102 <br />