(RFP) for Recovery Audit Contractor (RAC) - Texas Health and ...

e. Establish a Governance process with HHSC and hold Governance meetings on a
schedule as determined by HHSC; the governance meetings will serve as a means to
establish processes for all audits and also serve as a means to monitor the project and
escalate issues.
f. Coordinate with a State designee(s) for all audit activities and communication between
the Texas Medicaid claims administrator, managed care organizations, and other Health
and Human Services Enterprise agencies including the Office of Inspector General
(OIG), the Department of Aging and Disability Services (DADS), Department of
Assistance and Rehabilitative Services (DARS), the Department of Family and
Protective Services (DFPS), and the Department of State Health Services (DSHS), as
appropriate.
g. Furnish all material, labor, computers, software, equipment and supplies necessary to
perform their services.
h. Be responsible for all travel expenses.
i. Not remove any original records from the State offices.
j. Provide postage, long distance phone service, and email services for their staff; HHSC
will not pay for incidental expenses related to the recovery audit(s) and/or fraud-related
audit services.
k. Follow all federal and state related laws, statutes, rules and contract terms in its
recovery audit(s) and fraud-related audit activities.
l. Retain all audit documentation for three years following the final payment under this
contract or the date upon which all questions involving the improper payments and
fraudulent activities validity are resolved, whichever happens last.
2.3.2. Identification of Specific Providers for Audit (Provider Based
Approach)
a. Audits of Medicaid providers shall be based on such activities as improper payment risk
assessments, regression, digital analysis, data mining, and other risk assessment or
error detection techniques. Provider audits may also be indicated by HHSC based on
other sources of information, including complaints, investigations, other audits, etc.
b. Provide timeline for each proposed provider audit, format to be determined by HHSC, for
approval by HHSC prior to the start of audit activities. The timeline should include all
audit activities associated with the audit, including proposed major milestones such as
engagement letter, entrance conference, exit conference, preliminary draft report, final
draft report, final report.
2.3.3. Identification of Specific Claims for Audit (Claims Based Approach)
a. Provide a timeline for each audit type as determined by HHSC for approval by HHSC
prior to the start of audit activities for each audit type. The timeline should include all
audit activities associated with the audit type beginning with submittal of audit concepts
17