MB-10501 - USA (South Dakota) - Employee Health Plan Medical Claims Audit Service - Deadline October 23,2026

(1) Vendor needs to provide employee health plan medical claims audit service. – Perform the medical claims audit in accordance with generally accepted government auditing standards.– Follow industry–standard methodologies for medical and pharmacy claims auditing, including statistically valid sampling techniques.– Maintain auditor independence, appropriate qualifications, and relevant experience in health plan and claims audits.– Provide documentation and work papers sufficient for the state to validate findings, conclusions, and recommended corrections.– Verify that claims are being processed in compliance with the state’s plan provisions.– Measure the quality and timeliness of claims processing performance.– Assess the reliability of self–reported results for performance guarantees.(2) All the questions must be submitted no later than October 12, 2026.