Sec. 10.25.08.04. Audits

In order to verify the validity, reliability, and comparability of HEDIS and other performance measures required by the Commission, a carrier shall participate in certified audits as specified by the Commission, which may include:

(1) A process audit;

(2) One or more site visits;

(3) Specification and source code review and verification; and

(4) Medical records review.

Each carrier that is required to participate or elects to participate in the health benefit plan quality and performance evaluation system shall submit audited HEDIS and other performance measures for each designated health benefit plan for the reporting period to the Commission or its contractor by June 1 of the reporting period.

Within the time period specified by the Commission, a carrier shall correct inaccurate or incomplete data contained in its performance measures report that become apparent during the audit or other process.