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Internal Audit Services for Health Claims Recovery Engagement


Location
Maryland
Publication Date
05/10/2019 12:23 PM EDT
Closing Date
05/22/2019 03:00 PM EDT
Issuing Organization
Montgomery College
Solicitation Number
Description

Specifications include, but are not limited to: Montgomery College’s Internal Audit and Advisory Services Director, along with the Human Resources office that oversees the College’s healthcare plans, is seeking a firm to perform a statistically valid, riskstratified, random sample Medical Claims Recovery Audit across several provider service types. The audit will include the following parameters: • Test period: 2018 claims. • There are 1,467 participants in the College’s plan with Cigna. • Approximately $20M was incurred in self-insured medical and prescription costs with Cigna in 2018. • The College maintains self-insured plans with Kaiser and Cigna. The audit scope will include the Cigna claims only. • Cigna will permit up to 300 claims. • Electronic audits are not permitted by Cigna in the College’s agreement. • The work will be performed on-site at Cigna, where needed, as the College does not maintain the claims data. • Strategy for developing the sample plan must address how risks will be identified, data collected, and controls assessed. • The audit will kick-off between June 18 - 24, 2019.

Source
http://cms.montgomerycollege.edu/EDU/Department2.aspx?id=4992 (opens in a new window)

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