Audit, Reviews and Evaluations Sample Clauses

Audit, Reviews and Evaluations. Preferred Provider will, at its expense, make all books, records, documents and other evidence relating to adultBasic and/or CHIP, as the case may be, and the services rendered by Preferred Provider to adultBasic/CHIP Members under the Preferred Provider Agreement and these Regulations, available for audit, review or evaluation by Blue Shield, applicable Official Bodies of the Commonwealth of Pennsylvania, or any of the preceding entities’ designated representatives. Preferred Provider will make such books and records available onsite, during normal business hours, or, as requested by Blue Shield or the Official Bodies of the Commonwealth of Pennsylvania, through the mail within fifteen (15) calendar days of any such request (in accurate, legible paper copies, unless otherwise indicated). Preferred Provider will cooperate with any such review or audit by assisting in the identification and collection of any books, records, data or clinical records, and by making appropriate practitioners, other employees and involved parties available for interviews upon request.

Audit, Reviews and Evaluations. Preferred Provider will, at its expense, make all books, records, documents, and other evidence relating to CHIP, as the case may be, and the Provider Services rendered to CHIP Members under this Compliance Attachment and this Agreement, available for audit, review, or evaluation by Highmark, applicable Official Bodies or any of the preceding entities’ designated representatives. Preferred Provider will make such books and records available onsite, during normal business hours, or, as requested by Highmark or the Official Bodies of the Commonwealth of Pennsylvania, through the mail within fifteen (15) calendar days of any such request (in accurate, legible paper copies, unless otherwise indicated). Preferred Provider will cooperate with any such review or audit by assisting in the identification and collection of any books, records, data, or clinical records, and by making appropriate practitioners, other employees and involved parties available for interviews upon request. The following additional requirements consistent with 42 C.F.R. § 438.230(c)(3) shall apply to Preferred Provider: 5.3.24.1 The Commonwealth of Pennsylvania “Commonwealth”, CMS, the HHS Inspector General, the Comptroller General, or their designees have the right to audit, evaluate, and inspect any books, records, contracts, computer or other electronic systems of Preferred Provider, or of Preferred Provider's contractor, that pertain to any aspect of services and activities performed, or determination of amounts payable under the Highmark’s CHIP contract with the Commonwealth. 5.3.24.2 Preferred Provider will, at no cost, make available, for purposes of an audit, evaluation, or inspection under subsection (i) of this section, its premises, physical facilities, equipment, books, records, contracts, computer or other electronic systems relating to CHIP enrollees. 5.3.24.3 The right to audit under subsection (i) of this section will exist through ten (10) years from the final date of the CHIP contract between Highmark and the Commonwealth or from the date of completion of any audit, whichever is later. 5.3.24.4 If the Commonwealth, CMS, or the HHS Inspector General determines that there is a reasonable possibility of fraud or similar risk, the Commonwealth, CMS, or the HHS Inspector General may inspect, evaluate, and audit the Preferred Provider at any time.