(a) Providers shall designate an individual to coordinate all claim audit activities. An audit coordinator shall have the same qualifications as required for an auditor pursuant to § 9085 of this title. The duties of an audit coordinator include, among others, the following:\n(1) Scheduling an audit to be carried out during business hours;\n(2) advising other provider personnel and departments of a pending audit;\n(3) ensuring that the condition of admission statement is part of the clinical record;\n(4) verifying that the auditor is an authorized representative of the health insurance organization or issuer;\n(5) gathering the necessary documents for the audit;\n(6) coordinating auditor requests for information, space in which to conduct an audit, and access to records and provider personnel;\n(7) orienting auditors with respect to the provider’s audit procedures, record documentation conventions, and billing practices;\n(8) acting as a liaison between the auditor and other personnel of the provider;\n(9) conducting an exit interview with the auditor to answer questions and review audit findings;\n(10) reviewing the auditor’s final written report and following up on any charges l of the provider;\n(9) conducting an exit interview with the auditor to answer questions and review audit findings;\n(10) reviewing the auditor’s final written report and following up on any charges still in dispute;\n(11) arranging for payment as applicable, and\n(12) arranging for any required adjustment to bills or refunds.\nHistory —Aug. 29, 2011, No. 194, § 6.070, eff. 180 days after Aug. 29, 2011; July 10, 2013, No. 55, § 9, eff. 30 days after July 10, 2013.
Puerto Rico Legal Code