The purpose of this chapter is to provide for the standardization of claim audits of bills for healthcare services presented to health insurance organizations or issuers, third party administrators, or any other health plans. Such audits shall be carried out to determine whether data in a healthcare record of a provider is supported by services listed on the claim for payment of an enrollee or a provider. It is also intended to alleviate the potential conflict of the audit with medical uses of the health record and to reduce the cost entailed by unnecessary audits.\nHistory —Aug. 29, 2011, No. 194, § 6.020, eff. 180 days after Aug. 29, 2011.
Puerto Rico Legal Code