Specifications include, but are not limited to: Conduct a performance review audit of the medical claims process performed by Wellmark for thefollowing three (3) audit periods:Audit Period 1 is Fiscal Year 2022 - July 1, 2021, to June 30, 2022;Audit Period 2 will be Fiscal Year 2023 - July 1, 2022, to June 30, 2023; andAudit Period 3 will be Fiscal Year 2024 - July 1, 2023, to June 30, 2024.3.2Electronic Screening of 100.00% of paid Medical Claims for each audit period.3.3For each audit period the electronic screening of 100.00% of paid medical claims must measure:a.Claims processing accuracy rate – The incidence of claims processed without error;b.Payment incidence accuracy rate – The incidence of claims processed without payment error;c.Financial accuracy rate – The percentage of paid dollars processed without error;d.Claims turnaround time – The percentage of claims processed within fourteen (14) and thirty(30) calendar days; ande.Identification of recovery/savings potential.
