Access to Provider Records. The PH-MCO’s Fraud and Abuse policies and procedures must provide and certify that the PH-MCO’s Fraud and Abuse unit has access to records of Network Providers.
Access to Provider Records. The CHC-MCO’s Fraud, Waste and Abuse policies and procedures must provide and certify that the CHC-MCO’s Fraud, Waste and Abuse unit, as well as the entire Department, and the Pennsylvania Office of Attorney General Medicaid Fraud Control Section, has timely access to records of Network Providers, Subcontractors, and the CHC-MCOs.
Access to Provider Records. The Contracted Provider agrees to provide at no cost to the following entities or their designees with prompt, reasonable, and adequate access to this Agreement and any records, books, documents, and papers that relate to this Agreement and/or the Contracted Provider’s performance of its responsibilities under this contract for purposes of examination, audit, investigation, contract administration, the making of copies, excerpts or transcripts, or any other purpose NC DHHS deems necessary for contract enforcement or to perform its regulatory functions:
i. The United States Department of Health and Human Services or its designee;
ii. The Comptroller General of the United States or its designee;
iii. The North Carolina Department of Health and Human Services (NC DHHS), its Medicaid managed care program personnel, or its designee
iv. The Office of Inspector General
v. North Carolina Department of Justice Medicaid Investigations Division
vi. Any independent verification and validation contractor, audit firm, or quality assurance contractor acting on behalf of NC DHHS;
vii. The North Carolina Office of State Auditor, or its designee viii. A state or federal law enforcement agency.
Access to Provider Records. The PH-MCO’s Fraud, Xxxxx and Abuse policies and procedures must provide and certify that the PH-MCO’s Fraud, Waste and Abuse unit as well as the entire Department, the Pennsylvania Office of Attorney General
Access to Provider Records. Provider agrees to provide Alliance access to all books, records, and documents maintained under the Contract during normal business hours so that Alliance may perform its audit obligations, provided that any such access shall be consistent with applicable State and Federal laws and regulations. Provider and Alliance agree that all such documents shall be kept confidential, consistent with applicable State and Federal laws and regulations and Controlling Authority. Provider further agrees that surveys, reviews and/or audits performed by accrediting or regulatory authorities of Provider utilized to confirm operational compliance of or require corrective action by Provider shall be provided to Alliance upon Provider’s receipt.
Access to Provider Records. The Provider agrees to provide at no cost to the following entities or their designees with prompt, reasonable, and adequate access to the PIHP and Provider Contract/Agreement and any records, books, documents, and papers that relate to the PIHP and Provider Contract/Agreement and/or the Provider’s performance of its responsibilities under this contract for purposes of examination, audit, investigation, contract administration, the making of copies, excerpts or transcripts, or any other purpose NC DHHS deems necessary for contract enforcement or to perform its regulatory functions: The United States Department of Health and Human Services or its designee; The Comptroller General of the United States or its designee; The North Carolina Department of Health and Human Services (NC DHHS), its Medicaid Managed Care program personnel, or its designee The Office of Inspector General North Carolina Department of Justice Medicaid Investigations Division Any independent verification and validation contractor, audit firm, or quality assurance contractor acting on behalf of NC DHHS; The North Carolina Office of State Auditor, or its designee A state or federal law enforcement agency. And any other state or federal entity identified by NC DHHS, or any other entity engaged by NC DHHS. The Provider shall cooperate with all announced and unannounced site visits, audits, investigations, post-payment reviews, or other Program Integrity activities conducted by the NC Department of Health and Human Services. Nothing in this section shall be construed to limit the ability of the federal government, the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services Office of Inspector General, the U.S. Department of Justice, or any of the foregoing entities' contractors or agents, to enforce federal requirements for the submission of documentation in response to an audit or investigation. (Attachment X.x.xx p. 323)
Access to Provider Records. Provider agrees to provide at no cost to the following entities or their designees with prompt, reasonable, and adequate access to Agreement and any records, books, documents, and papers that relate to Agreement and/or the Provider’s performance of its responsibilities under the Agreement for purposes of examination, audit, investigation, contract administration, the making of copies, excerpts or transcripts, or any other purpose Department deems necessary for contract enforcement or to perform its regulatory functions:
i) The United States Department of Health and Human Services or its designee;
ii) The Comptroller General of the United States or its designee;
iii) Department, its Medicaid managed care program personnel, or its designee;
iv) The Office of Inspector General;
v) North Carolina Department of Justice Medicaid Investigations Division;
vi) Any independent verification and validation contractor, audit firm, or quality assurance contractor acting on behalf of Department;
Access to Provider Records. (a) Participating Provider agrees to provide at no cost to the following entities or their designees with prompt, reasonable, and adequate access to Carolina Complete or Payor and the Agreement and any records, books, documents, and papers that relate to Carolina Complete or Payor and the Agreement and/or Participating Provider’s performance of its responsibilities under this Agreement for purposes of examination, audit, investigation, contract administration, the making of copies, excerpts or transcripts, or any other purpose NC DHHS deems necessary for contract enforcement or to perform its regulatory functions: (i) the United States Department of Health and Human Services or its designee; (ii) the Comptroller General of the United States or its designee; (iii) NC DHHS, its Medicaid managed care program personnel, or its designee; (iv) the Office of Inspector General; (v) North Carolina Department of Justice Medicaid Investigations Division; (vi) any independent verification and validation contractor, audit firm, or quality assurance contractor acting on behalf of NC DHHS; (vii) the North Carolina Office of State Auditor, or its designee; (viii) a state or federal law enforcement agency; and (ix) any other state or federal entity identified by NC DHHS, or any other entity engaged by NC DHHS.
(b) Participating Provider shall cooperate with all announced and unannounced site visits, audits, investigations, post-payment reviews, or other program integrity activities conducted by the NC DHHS.
(c) Nothing in this section shall be construed to limit the ability of the federal government, the Centers for Medicare and Medicaid Services, the U.S. Department of Health and Human Services Office of Inspector General, the U.S. Department of Justice, or any of the foregoing entities’ contractors or agents, to enforce federal requirements for the submission of documentation in response to an audit or investigation. (Section VII, G(3)(f)).
Access to Provider Records. 3.3.1 Provider agrees that Anthem or its authorized representative may review, audit, and duplicate data and other records maintained by Provider regarding services Provider provides to Covered Individuals, and the cost thereof to the extent permitted by state and federal law including but not limited to the Agreement between Anthem and the Department of Health Care Services. Records include but are not limited to: medical and clinical records, encounter data, and records relating to billing, payment and assignment. Provider shall make such records and information available to Anthem or its authorized representative at all reasonable times at Provider’s place of business upon Anthem’s request. Such books and records shall be made available to Anthem in a form maintained in accordance with the general standards applicable to such books or record keeping.
3.3.2 Provider further agrees that the Directors or their designated representatives from the California Department of Managed Health Care, the California Department of Health Care Services, the Department of Health and Human Services (“DHHS”), the Centers for Medicaid and Medicare Services (“CMS”), Inspector General and the Department of Justice may inspect, audit and copy all financial, medical or other records maintained by Provider as may be necessary to ensure Anthem's compliance with the requirements of the Xxxx-Xxxxx Act, the Medi-Cal program, or Anthem’s contract with DHCS. [42 CFR 438.6(g)] Access to Provider’s records and data for any government inspection shall be consistent to the access provided to Anthem under section 3.3.1. Should any governmental regulatory entity request certified documents, information, or data as part of that entity’s inspection or audit, Provider agrees to have an authorized officer certify the accuracy of the documents, information or data produced by Provider. Furthermore, Provider agrees to make available all of its premises, facilities, equipment, books, records, contracts, computer and other electronic systems pertaining to the services Provider provides to Covered Individuals furnished under the terms of this Agreement.
3.3.3 Provider agrees that it will maintain its books, records and other papers for at least ten (10) years from the final date of the Medi-Cal Managed Care Program Agreement between Anthem and the Department of Health Care Services or from the date of completion of any audit, whichever is later. In addition, such obligation will not terminate upon ...
Access to Provider Records. PO agrees to provide at no cost to the following entities or their designees with prompt, reasonable, and adequate access to the [Plan and PO Contract] and any records, books, documents, and papers that relate to the [Plan and PO Contract] and/or PO’s performance of its responsibilities under this contract for purposes of examination, audit, investigation, contract administration, the making of copies, excerpts or transcripts, or any other purpose NC DHHS deems necessary for contract enforcement or to perform its regulatory functions:
i. The United States Department of Health and Human Services or its designee;
ii. The Comptroller General of the United States or its designee;
iii. The North Carolina Department of Health and Human Services (NC DHHS), its Medicaid man-aged care program personnel, or its designee;
iv. The Office of Inspector General;
v. North Carolina Department of Justice Medicaid Investigations Division;
vi. Any independent verification and validation contractor, audit firm, or quality assurance con-tractor acting on behalf of NC DHHS;
vii. The North Carolina Office of State Auditor, or its designee; viii. A state or federal law enforcement agency;
