Common use of Service Verification Clause in Contracts

Service Verification. (A) The Contractor shall have policies and procedures to verify that services billed by Providers were received by the Contractor’s Enrollees. The Contractor’s policies and procedures must include the following: (1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the state fiscal year (SFY) for service verification; and (2) the Contractor shall keep a record of each Enrollee contacted for service verification. (B) By November 1st of each year, the Contractor shall submit a report to the Department, in a Department specified format: (1) the names and ID numbers of all Enrollees contacted for service verification; (2) whether the Enrollees were contacted via telephone, email, or other method; (3) whether the Enrollee responded to the service verification; and (4) whether the Enrollee indicated he or she obtained the service during the prior fiscal year. (C) The Parties understand and agree that the Department will annually conduct an audit to ensure that the service verification was conducted by the Contractor. The Contractor shall keep sufficient documentation to ensure that the Department can verify that the service verification was performed.

Service Verification. (A) The Contractor shall have policies and procedures to verify that services billed by Providers were received by the Contractor’s Enrollees. The Contractor’s written policies and procedures must include the following: (1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the state fiscal year (SFY) for service verification; and (2) the Contractor shall keep a record of each Enrollee contacted for service verification. (B) By November 1st of each year, the Contractor shall submit a report to the Department, in a Department specified formatformat that includes: (1) the names and ID numbers of all Enrollees contacted for service verification; (2) whether the Enrollees were Enrollee was contacted via telephone, email, or other method; (3) whether the Enrollee responded to the service verification; and (4) whether the Enrollee indicated he or she obtained the service during the prior fiscal year. (C) The Parties understand and agree that the Department will annually conduct an audit to ensure that the service verification was conducted by the Contractor. The Contractor shall keep sufficient documentation to ensure that the Department can verify that the service verification was performed.