Specifications include, but are not limited to: Account Management Must comply with staffing minimum requirements provided in RFP Section 3.2 through 3.5. All other services directly related to this contract must be provided from an office located within the United States. Medical Claims and Performance Audit Services At the request of the Board, at least annually perform a comprehensive and objective medical claims and performance audit of the Plan’s medical claims third party administrator to determine if the medical claims were adjudicated according to appropriate Plan benefits, the contractual standards, industry standards, and State and federal regulations. The medical claims and performance audit must be based on a statistically valid stratified random sample that achieves a minimum 95% confidence level +/-3%, and must include at a minimum the results for the following key performance indicators: financial accuracy, payment accuracy, processing accuracy, and claims processing turnaround time. The audit must include a review of the medical claims processed by the medical claims third party administrator, including re-adjudicating medical claims to evaluate the administrator’s processes and systems relating to such areas as: eligibility, coding, pricing (including proper application of allowable charge and discount arrangements), deductible accumulators, identification of duplicate bills, application of Plan benefits, COB, subrogation, medical necessity, ineligible/eligible charges, compliance with the Plan Document, timeliness of processing, interaction with other vendors, and file documentation
