Specifications include, but are not limited to: • Conduct a comprehensive industry benchmark risk based professional coding audit of medical record
documentation to identify missed professional billing opportunities and to ensure the professional services billed
comply with CPT/HCPCS/ICD-10-CM guidelines, third party payer billing regulations, compliance program
standards, and documentation requirements.
• The frequency of the audit process will be monthly and moving to quarterly with no more than 50 providers per
specialty division. The number of claims to audit will be established based on Supplier's sample selected per
specialty, not to exceed 1000 encounters.