Common use of Maintenance and Audit Clause in Contracts

Maintenance and Audit. You agree to maintain legible, complete, timely, accurate, and professionally adequate and appropriate medical and other health records relating to services and/or supplies provided to State Health Plan Members in accordance with our Policies and Procedures, accepted industry standards, and as may be required by law. You agree to maintain medical records on the same basis as for all other patients, and to make such information available to us and other North Carolina State Health Plan Network providers when necessary for the treatment and evaluation of State Health Plan Members or as otherwise required by our Policies and Procedures or determined by us, as permitted by law or the terms and conditions governing the State Health Plan Member’s Benefit Plan. You agree that we or our designated representative have the right upon thirty (30) days prior Written Notice, to inspect and audit at reasonable times your medical and financial records relating to services and/or supplies provided to State Health Plan Members and the administration of this Agreement. You agree that all data submitted to us on State Health Plan Members shall be accurate, complete, and truthful, and to provide us with records necessary to confirm the accuracy, completeness, and truthfulness of such data. You further agree there will be no charge or other administrative fee to us, our designated representative, or the State Health Plan Member related to our performance of any audit or your duplication and submission of copies of such records reasonably requested in the performance of such audits. Such right of audit may be for the purpose of complying with requests of the North Carolina Department of Insurance, verifying services provided, verifying contract compliance, or such other lawful purposes as we may require or as are provided for in our Policies and Procedures. Notwithstanding the above, no prior written notice shall be required when we inspect and audit based on suspected fraud or abuse.