Right to Audit Claims Clause Samples

The Right to Audit Claims clause grants one party the authority to review and examine the records and documentation related to claims submitted under a contract. In practice, this means the party with audit rights can inspect invoices, supporting documents, and other relevant materials to verify the accuracy and legitimacy of claims for payment or reimbursement. This clause serves to ensure transparency, prevent fraud, and resolve disputes by allowing for independent verification of claims.
Right to Audit Claims. Upon providing forty five (45) days advance written notice to the other, each Party shall have the right to inspect and copy the records of the other that are pertinent to the operation of the Plan. The rights set forth in this Section will continue for a two (2) year period immediately following each Contract Year and any such audit shall cover the two-year period immediately preceding the audit commencement date. Any inspection shall take place only during regular business hours and only in accordance with the Company’s written Audit Agreement, which sets forth reasonable terms for the scope of the audit. The auditing Party shall prepare an audit report within thirty days after the completion of the audit and the Party being audited shall be given a copy of the report and have the right to review and provide comments on the audit report. The Parties shall maintain information reviewed or generated related to the audit, the results of the audit, the audit report and all materials related thereto as confidential and shall not release the information, results or report to any third party, except for Company or the Client, without the consent of the other Party. The parties agree that no proprietary materials may be copied or removed from the audit site. The auditing party shall not contact the other Party’s customers, Members, Contractors or vendors without the prior written consent of the other party. Any costs of such inspection shall be borne by the inspecting Party. The Parties shall cooperate with each other and make all reasonable efforts to confine any audit to a reasonable length of time, not to exceed five (5) business days during any twelve month period.
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Right to Audit Claims. Client may audit Company’s payment of Plan Benefits in accordance with the following requirements: A. Client shall provide to Company a scope of audit letter and the fully executed Claim Audit Agreement, a sample of which is attached hereto, together with a forty-five (45) day advance written request for audit. B. Client may designate with Company’s consent (which consent shall not to be unreasonably withheld) an independent, third-party auditor to conduct the audit (the “Auditor”). C. Client and Company will agree upon the date for the audit during regular business hours at Company’s office(s). D. Except as otherwise agreed to by the parties in writing prior to the commencement of the audit, the audit shall be conducted in accordance with the terms of Company’s Claim Audit Agreement attached hereto as “Claim Audit Agreement”, which is hereby agreed to by Client and which shall be signed by the Auditor prior to the start of the audit. E. If the audit identifies any claim adjustments, such adjustments will be made in accordance with this Agreement and based upon the actual claims reviewed and not upon statistical projections or extrapolations. F. Client shall be responsible for its Auditor’s costs. Client may (as determined by Company based upon the resources required by the audit requested) be responsible for Company’s reasonable costs with respect to the audit, except that while this Agreement is in effect there shall be no additional cost to Client for an audit of payment documents relating to a random, statistically valid sample of two-hundred twenty-five (225) claims paid during the two prior Plan years and not previously audited, provided that if Client has five thousand (5,000) or more employees who are Members, Client may conduct one such audit every Plan Year (but not within six (6) months of a prior audit); otherwise, Client ay conduct one such audit every two (2) Plan Years (but not within eighteen (18) months of a prior audit). In the event Client requests to alter the scope of the claim audit, Company will endeavor to reasonably accommodate the Client’s request, which may be subject to additional charges to be mutually agreed upon by the Client and Company prior to the start of the audit. In no event shall any audit involve Plan benefit payments made prior to the most recent two (2) plan years.
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Right to Audit Claims. (A) The Plan shall have the right to audit the accuracy of claims paid by PHE. Such audit shall be conducted in accordance with the standards established by the Plan and as otherwise required by federal and State regulators and/or Accreditation Agencies and shall consist of a review of a statistically valid sample of such claims, and shall further be governed by the provisions of the Provider Guide and applicable regulations. Such audit shall be during normal business hours of PHE. The audit shall consist of a review of those records whose review PHE and the Plan agree is necessary to determine the accuracy of said claim adjudication. The Plan, at its own cost, may engage a third party to conduct such audit on its behalf, provided that such third party agrees in writing to the limitations on right to audit set forth in Subsection (b) below. (B) With respect to any audit of PHE's information and records pursuant to this section, the Plan agrees that (i) the information and records will be kept confidential, provided that the Plan's disclosure of ------------- such information to governmental regulators and Accreditation Agencies to the extent required shall not constitute a violation of this confidentiality obligation; (ii) the Plan shall comply with all federal, state, and local laws regarding the confidentiality of health care information; and (iii) no original record (or copies thereof) may be removed from the site where the auditors locate such information except as required by any governmental regulators and Accreditation Agencies, in which case the Plan shall be permitted to make copies of documents necessary to comply with such regulators and/or Accreditation Agencies disclosure requirements. (C) The Plan shall bear all of its costs of such audit.
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Right to Audit Claims. (a) The Plan shall have the right to audit the accuracy of claims [**********] Such audit shall be conducted in accordance with the standards established by the Plan and as otherwise required by federal and State regulators and/or Accreditation Agencies [*** ***************************************************************** ************************************************************** *****************************************] Such audit shall be during normal business hours of PHE. [*************************** ************************************************************** **************************************************************] The Plan, at its own cost, may engage a third party to conduct such audit on its behalf, provided that such third party agrees in writing to the limitations on right to audit set forth in Subsection (b) below. (b) With respect to any audit of PHE's information and records pursuant to this section, the Plan agrees that (i) the information and records will be kept confidential, provided that ------------- the Plan's disclosure of such information to governmental regulators and Accreditation Agencies to the extent required shall not constitute a violation of this confidentiality obligation; (ii) the Plan shall comply with all federal, state, and local laws regarding the confidentiality of health care information; and (iii) no original record (or copies thereof) may be removed from the site where the auditors locate such information except as required by any governmental regulators and Accreditation Agencies, in which case the Plan shall be permitted to make copies of documents necessary to comply with such regulators and/or Accreditation Agencies disclosure requirements. (c) The Plan shall bear all of its costs of such audit.
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Related to Right to Audit Claims

  • Right to Audit During the term of this Agreement and not more than once per year (unless circumstances warrant additional audits as described below), Servicer may audit the Asset Representations Reviewer’s policies, procedures and records that relate to the performance of the Asset Representation Reviewer under this Agreement to ensure compliance with this Agreement upon at least 10 business days’ notice. Notwithstanding the foregoing, the parties agree that Servicer may conduct an audit at any time, in the event of (i) audits required by Servicer’s governmental or regulatory authorities, (ii) investigations of claims of misappropriation, fraud, or business irregularities of a potentially criminal nature, or (iii) Servicer reasonably believes that an audit is necessary to address a material operational problem or issue that poses a threat to Servicer’s business.

  • Right to Audit Records Citizens shall have reasonable access to Vendor’s facilities and the right to review and audit any of Vendor’s records relating solely to this Agreement, upon written notice to Vendor of at least three (3) business days. Vendor shall not unreasonably delay or inhibit Citizens’ right to audit as set forth in this Section. Vendor shall cooperate with auditor(s) and, provide requested documentation in a timely manner (preferably within five (5) business days). Vendor must resolve any deficiencies discovered during the audit within ninety (90) calendar days from being reported. Citizens may extend the response time period in its sole discretion. Citizens has the right to conduct follow-up audit procedures to assess Vendor’s corrective action(s). Any entity performing auditing services pursuant to this Section shall execute a non-disclosure agreement with regard to Vendor’s proprietary information, unless precluded from doing so by law. Vendor agrees to reimburse Citizens for the reasonable costs of investigation incurred by Citizens for investigations of Vendor’s compliance with this Agreement which result in termination for cause or in regulatory or criminal penalties in connection with performance of this Agreement. Such costs shall include, but shall not be limited to: salaries of investigators, including overtime; travel and lodging expenses; expert witness fees and, documentary fees.

  • Agency’s Right to Audit A. Grantee shall make available at reasonable times and upon reasonable notice, and for reasonable periods, work papers, reports, books, records, supporting documents kept current by Grantee pertaining to the Grant Agreement for purposes of inspecting, monitoring, auditing, or evaluating by System Agency and the State of Texas. Grantee shall ensure these same requirements are included in all subcontracts. B. In addition to any right of access arising by operation of law, Grantee and any of Grantee’s affiliate or subsidiary organizations, or Subcontractors shall permit the System Agency or any of its duly authorized representatives, as well as duly authorized federal, state or local authorities, unrestricted access to and the right to examine any site where business is conducted or services are performed, and all records, which includes but is not limited to financial, client and patient records, books, papers or documents related to this Grant Agreement. Grantee shall permit the System Agency or any of its duly authorized federal, state, or local authorities unrestricted access to and the right to examine all external contracts and or pricing models or methodologies related to the Grant Agreement. Grantee shall ensure these same requirements are included in all subcontracts. If the Grant Agreement includes federal funds, federal agencies that shall have a right of access to records as described in this section include: the federal agency providing the funds, the Comptroller General of the United States, the General Accounting Office, the Office of the Inspector General, and any of their authorized representatives. In addition, agencies of the State of Texas that shall have a right of access to records as described in this section include: the System Agency, HHS's contracted examiners, the State Auditor’s Office, the Office of the Texas Attorney General, and any successor agencies. Each of these entities may be a duly authorized authority. C. If deemed necessary by the System Agency or any duly authorized authority, for the purpose of oversight, including, but not limited to, reviews, inspections, audits and investigations, Grantee shall produce original documents related to this Grant Agreement. D. The System Agency and any duly authorized authority shall have the right to audit ▇▇▇▇▇▇▇▇ both before and after payment, and all documentation that substantiates the ▇▇▇▇▇▇▇▇ and payments related to the Grant Agreement, including those related to a Subcontractor. E. Grantee shall include the System Agency’s and any of its duly authorized representatives’, as well as duly authorized federal, state, or local authorities, unrestricted right of access to, and examination of, sites and information related to this Grant Agreement in any Subcontract it awards.

  • State Auditor’s Right to Audit The state auditor may conduct an audit or investigation of any entity receiving funds from the state directly under the Grant Agreement or indirectly through a subcontract under the Grant Agreement. The acceptance of funds directly under the Grant Agreement or indirectly through a subcontract under the Grant Agreement acts as acceptance of the authority of the state auditor, under the direction of the legislative audit committee, to conduct an audit or investigation in connection with those funds. Under the direction of the legislative audit committee, an entity that is the subject of an audit or investigation by the state auditor must provide the state auditor with access to any information the state auditor considers relevant to the investigation or audit. Grantee shall ensure the authority to audit funds received indirectly by subcontractors through the contract and the requirement to cooperate is included in any subcontract it awards.

  • RECORDS; RIGHT TO AUDIT (a) The Sub-Adviser agrees to maintain in the form and for the period required by Rule 31a-2 under the 1940 Act, all records relating to the Fund's investments made by the Sub-Adviser that are required to be maintained by the Fund pursuant to the requirements of Rule 31a-1 under the 1940 Act. The Sub-Adviser agrees that all records that it maintains on behalf of the Fund are the property of the Fund, and the Sub-Adviser will surrender promptly to the Fund any such records upon the Fund's request; provided, however, that the Sub-Adviser may retain a copy of such records. In addition, for the duration of this Agreement, the Sub-Adviser shall preserve for the periods prescribed by Rule 31a-2 under the 1940 Act any such records as are required to be maintained by it pursuant to this Agreement and shall transfer all such records to any entity designated by the Adviser upon the termination of this Agreement. (b) The Sub-Adviser agrees that all accounts, books and other records maintained and preserved by it as required hereby will be subject at any time, and from time to time, to such reasonable periodic, special and other examinations by the SEC, the Fund's auditors, any representative of the Fund, the Adviser, or any governmental agency or other instrumentality having regulatory authority over the Fund.