Program Integrity Lead. The Contractor shall designate a PI Lead who will represent the Contractor and be accountable to communicate PI detection activities, fraud case tracking, investigative procedures, and pre- and post- claim edits, PA/SA review, and any other fraud activities and outcomes. This individual must also attend all scheduled meetings of the Department’s Quarterly Program Integrity Collaborative. If the PI Lead is unable to attend the PI Collaborative, the Contractor must notify the Department prior to the meeting and identify an alternative representative who will be in attendance. The Contractor must be aware and actively involved with State, Federal, and CMS initiatives of Program Integrity.
Appears in 2 contracts
Sources: Managed Care Services Agreement, Managed Care Services Agreement
Program Integrity Lead. The Contractor shall designate a PI Lead who will represent the Contractor and be accountable to communicate PI detection activities, fraud case tracking, investigative procedures, and pre- and post- claim edits, PA/SA review, and any other fraud activities and outcomes. This individual must also attend all scheduled meetings of the Department’s Quarterly Program Integrity Collaborative. If the PI Lead is unable to attend the PI Collaborative, the Contractor must notify the Department prior to the meeting and identify an alternative representative who will be in attendance. The Contractor must be aware and actively involved with State, Federal, and CMS initiatives of Program Integrity.
Appears in 1 contract
Sources: Managed Care Services Agreement