Specifications include, but are not limited to: Audits will be conducted for the self-funded plan options for TRS-Care and TRS-ActiveCare. Each medical audit requires a Comprehensive 100%-of-Claims Audit. Claim accuracy Determine whether claims payments are accurate, allowable, adjudicated, and paid in accordance with contractual arrangements. This includes out-of-network and emergency claims. Contract compliance Determine whether vendor complied with key contract provisions, including plan design details. Key Performance measurement reporting Determine whether key contractual performance guarantees (as decided by TRS) were reported completely and accurately to TRS and all fines were paid as required. ; Review the HPA’s operations, controls, and procedures that influence or impact the administration of TRS’ health claims through a comprehensive procedural questionnaire, interviews with key management personnel, and site visits as necessary. Examples of operational areas may include: i. Hospital audits ii. Claim processing iii. Subrogation and other third party recoveries iv. Customer Services v. Eligibility and Enrollment Processing vi. Quality Assurance vii. Special Investigation Unit recoveries and protocols.