The Vendor shall provide an Enhanced Provider Network Auditing (EPNA) program for SMMC plans as outlined in this Contract. The EPNA program shall assist the Agency with ensuring the accuracy of and access to the provider networks reported by the Managed Care Plans in addition to implementing processes that hold Managed Care Plans accountable for maintaining adequate provider networks. At a minimum, the goals of the Contract include the following: 1. Continuously audit and test the provider networks reported and maintained by the Managed Care Plans. Special emphasis shall be given to onsite reviews. 2. Receive network access complaints from the Agency’s Recipient and Provider Assistance (RPA) bureau and research/audit the alleged network deficiency to determine potential findings. 3. Address and monitor identified network deficiencies with the Managed Care Plans to ensure appropriate remediation. 4. Provide reports including analytics, dashboards, and reports of Vendor findings and activities.
