BMI Inc 4/3/2019 - Laserfiche WebLink

c;ny of twerett Healthcare Management Administrators Audit Agreement-2019 6. Applicabiility.to other Blue Cross Blue Shield Plans.The parties acknowledge that other Blue Cross and Blue Shield Plans("Host Plans") may have paid claims on behalf of the Group and,if so,that Confidential Information includes proprietary information from Host Plans. Audit agrees to afford such Host Plans with the same confidentiality as provided in this Agreement and such Host Plans will be held harmless to the same extent as HMA and Regence herein. AUDIT PROCEDURES I. Scope of Audit The scope of the audit must be established and agreed to by HMA prior to initiation of any audit. Proposed additions or changes to audit scope must be conveyed in writing and approved by HMA prior to implementation of any change in audit scope. Scope should be documented in sufficient detail such that audit approach,sampling methodology, error handling, and reporting can be readily discerned. Regence will provide access to its contracts with Participating Providers only(i)for the purpose of ensuring that a claim was correctly paid by the claims processing system at the appropriately contracted rate, and(ii)only in a manner that Regence deems would protect the confidential and/or proprietary information contained therein. Contract review will be limited to number of claims agreed to within the Audit Scope Letter. A designated Regence employee will assist the auditor during this review allowing use of the system computer for the sampled claims and other information related to complete this audit. Any claims discovered which involve possible fraud shall be reported to HMA as soon as reasonably possible. 2. Auditor Conduct Unless otherwise agreed by Regence,all audits will be conducted at the HMA and Regence offices. HMA and Regence will provide Auditor with commercially reasonable working facilities in its existing offices and the audit will be conducted during HMA and Regence's normal working hours. Auditor shall,while on the premises of Regence,comply with all facility rules and regulations of Regence. Furthermore, Auditor shall not, in the conduct of the audit, stop, delay, or otherwise interfere with the ongoing work of Regence on unrelated projects. • 3. Limitations on Audits Auditors must be compensated by Group at an agreed upon fixed rate;contingent fee or recovery auditors will not be granted access to HMA or Regence facilities or data. HMA will not be obligated to reimburse Group for alleged errors based upon its use of extrapolation methodologies for the purpose of inferring errors in a population of claim payments based upon the error rate in a sample drawn from that population. Data subject to audit shall be Iimited to that processed during the current contract period and one year immediately preceding current contract period,not to exceed 24 months. In the event that more than 24 months have elapsed since HMA or Regence's processing of Group's claims,those claims shall not be subject to audit without the express written consent of Regence. 2