Schedule A Statement of WorkREVISED.docx

Michigan.gov/MiProcurement

SCHEDULE A - STATEMENT OF WORK1. CONTRACT ACTIVITIES

Request for Proposal No. 240000001383 Long Terms Disability Insurance Administration Services This schedule identifies the anticipated requirements of any Contract resulting from this Request For Proposal (RFP). The term “Contractor” in this document refers to a bidder responding to this RFP, as well as the Contractor who is awarded the contract. The term “Bidder” is used to identify where specific responses to the RFP are required. The Contractor must respond to each requirement or question and explain how it will fulfill each requirement. Attach any supplemental information and appropriately reference within your response.

IMPORTANT NOTE TO CONTRACTORS/BIDDERS: There are specific requirements for which acceptance must be simply acknowledged through a checkbox(es), and others that require further explanation. Click the appropriate checkbox and complete the entries as appropriate.

BACKGROUND

The Michigan Civil Service Commission (MCSC)(Plan Sponsor) administers a self-insured Long Term Disability (LTD) benefit plan which provides wage loss benefits for disabled State of Michigan employees. This benefit is an optional employee selection and is only available to State employees enrolled in the plan.

SCOPE

This request is for proposals for an administrative services only (ASO) contract to provide third party claims administration for the LTD Income Protection Plan for the MCSC. The Contractor must, in part, provide claims administration, claim processing, claim investigation, claim reporting, record keeping, overpayment recovery, appeal process administration, subrogation, dispute resolution, auditing and billing, claim reserving, claims investigation for disability claims from individuals enrolled in the program.

The effective date of the contract is estimated to be October 1, 2024, through March 31, 2029, with six optional one-year renewals. The implementation period is October 1, 2024, through March 29, 2025; no payment will be made to the Contractor during the implementation period. The Contractor must commence performance of all Contract Activities, without interruption on March 30, 2025.

1. Requirements

1.1 General Requirements

1.1.1 The Contractor must provide a fully functional Long Term Disability (LTD) plan as defined by the MCSC.

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1.1.2 The Contractor must be a licensed Third-Party Administrator (TPA) in the State of Michigan or insurance company licensed to do business in Michigan, or must qualify in any other capacity as an entity that is properly licensed by statute to provide administrative services only and cost-plus arrangements, or to act as a TPA.

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1.1.3 The Contractor must partner with the Plan Sponsor to manage the Plan effectively and collaborate with the Plan Sponsor to provide Plan updates and services to ensure the ability of the Plan to continue to offer LTD coverage and support the Plan Sponsor’s strategic planning process.

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1.1.4 The Contractor must provide all administrative functions set forth in this Contract. This must include, but is not limited to: accurate eligibility determinations, claims administration, claim processing, claim investigation, claim reporting including incurred but not reported (IBNR) fund analysis, record keeping, overpayment recovery, appeal process administration, subrogation, dispute resolution, auditing and billing, claim reserving, and claims investigation for disability claims from individuals enrolled in the program.

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1.1.5 The Contractor must comply with the State of Michigan’s Public Act 454 of 2004 (Social Security Number Privacy Act).

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1.1.6 The Contractor must monitor, review and implement all legislation and guidance that applies to services provided under this Contract.

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1.1.7 The Contractor must provide exceptional customer service for MCSC personnel, Plan claimants and enrollees. See also Service Level Agreements (SLAs) in Schedule A, Section 10.

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1.1.8 The Contractor must provide support of strategic planning efforts and in identifying areas of improvement upon request including, but not limited to, comparative analysis of Plan Sponsor’s population to other like groups across Contractor’s book of business.

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1.1.9 The Contractor must maintain confidentiality of all data collected by the Contractor, according to all applicable laws, rules and regulations. See also Hybrid Contract Terms Section 37.

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1.2 Plan Design

1.2.1 The Contractor must administer LTD services in accordance with the Plan as outlined at the following link: LTD Plan Booklet (michigan.gov).

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1.2.2 This Plan is a bargained benefit and is subject to change throughout the duration of this Contract, depending upon the results of future collective bargaining agreements.

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1.2.3 The Contractor must be able to administer multiple plan designs based on bargained terms. The Plan Sponsor is asking for pricing proposals for the current plan design as well as for an additional short-term design under consideration (See also Schedule B, Pricing).

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1.2.4 The Contractor must implement Plan changes as requested by the Plan Sponsor or as required to comply with changes in law or regulation in a mutually agreed time frame, at no additional fee to the Plan Sponsor.

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1.2.5 The Contractor must not expand or reduce coverage for claimants without the Plan Sponsor’s written approval.

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1.3 Claimant/Employee Support

1.3.1 General Support

1.3.1.1 As a representative of the State of Michigan, contact with employees by the Contractor must be conducted in a polite and professional manner. Examiners or other representatives of the Contractor who conduct themselves in a manner deemed inappropriate by the Plan Sponsor must be removed from the State account. The State Program Manager may establish specific evaluation criteria. The decision of the State shall be final.

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1.3.1.2 The Contractor must assist the State of Michigan in developing informational material that informs the employee of their rights under the State’s LTD programs and must assure that information is readily provided to assist employees.

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1.3.1.3 The Contractor’s Customer Service team and Claim Adjuster team must respond to all inquiries from the Plan Sponsor and/or claimants/employees within one business day. See also Service Level Agreements (SLAs) in Schedule A, Section 10.

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1.3.1.4 The Contractor’s Customer Service team and Claim Adjuster team must manage all incoming and outgoing claimant calls, log the nature of the call and correspondence and associate records with the appropriate claim.

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1.3.1.5 The Contractor must use the information captured in the communication tracking system to target improvement opportunities (e.g., reducing call volume, providing online capabilities, identifying issues, etc.).

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1.3.1.6 The Contractor must review claim records for quality monitoring purposes.

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1.3.1.7 The Contractor must record and preserve 100% of incoming and outgoing calls for the life of the claim until exhaustion of appeal process. The State must have access to any recorded conversations upon Plan Sponsor request.

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1.3.1.8 The Contractor must notify the Plan Sponsor immediately of any developing situation that may impact operations or service to Claimants.

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1.3.1.9 The Contractor must be capable of addressing special needs of Claimants, including, but not limited to, TTY or relay services for the hearing impaired.

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1.3.1.10 Information on how to access Contractor’s Customer Service must be clearly communicated in all Plan-specific Claimant/Employee materials.

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1.3.2 Customer Service Call Center

1.3.2.1 The Contractor must provide a Customer Service call center, where it will maintain staff dedicated to supporting the needs of the Plan Sponsor’s Claimants/Employees. The call center must be in the United States of America, but the Plan Sponsor prefers that the call center be located in Michigan. The Contractor’s call center must be available to receive inbound calls Monday through Friday from 8:00 AM to 5:00 PM Eastern Standard Time (EST). The Customer Service call center must, at a minimum include:

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1.3.2.1.1 A single front-end toll-free telephone number with touch-tone routing (if necessary) established for Customer Service staff to respond to Claimant/Employee requests for claim reporting and questions on eligibility, claims, and addressing complaints.

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1.3.2.1.2 A customer service system that can handle a population of over 50,000 employees and is scalable to future demand if determined by Plan Sponsor.

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1.3.2.1.3 An advanced telephone system that provides the Plan Sponsor with management tracking and reporting capabilities.

· Methods for logging calls, recording call data and content.

· Methods to report metrics, standards and ad-hoc report generation.

· Methods to monitor calls for quality.

· An interactive voice response (IVR) system with a user-friendly menu.

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Bidder must describe Bidder’s current system or steps for implementation or development in your response:

1.3.2.2 The Contractor must attempt to resolve a Claimant’s issue during the initial contact with the Claimant. For those issues not resolved immediately, Contractor must contact Claimants about their issues within one business day of Claimant contact.

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Bidder must describe Bidder’s process for responding to telephone inquiries:

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1.3.6 Regarding Requirements in Section 1.3.3, 1.3.4, and 1.3.5 above:

Bidder must provide details of the services and functions that will be available to the Claimants/Employees on the Web and/or via mobile applications. See also Schedule A, Section 2.4 Mobile Responsiveness:

Bidder Response:

1.4 Claimant/Employee Communications Materials and Meetings

1.4.1 Communication Materials

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1.4.1.2 The Contractor must prepare and distribute, at its own cost, all planned Claimant/Employee communications and ad hoc communications where desired by the Plan Sponsor, including but not limited to announcements, letters, notices, brochures, forms, postage, and other supplies and services for U.S. mail distribution (and email at the Plan Sponsor’s discretion) to Claimants/Employees.

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1.4.1.3 Customized Claimant/Employee communications must be provided, by the Contractor at no additional charge and are subject to the Plan Sponsor’s approval. This also includes co-branding materials with the name of Contractor and Plan Sponsor, where desired by Plan Sponsor.

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1.4.2 Communication Meetings:

1.4.2.1 Contractor must provide staff to give presentations regarding LTD plans at no additional cost to the Plan Sponsor. Requests to attend or to speak at meetings may only come from Plan Sponsor. The number, location and nature of meeting requests may vary from year-to-year (but will not exceed 10) and may include State employees, union representatives, etc. Contractor must accept all Plan Sponsor requests for Contractor presentations within the State of Michigan. In the event Contractor is unable to accommodate a request, Contractor must obtain Plan Sponsor’s approval for excusal.

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1.4.3 Claimant Satisfaction:

1.4.3.1 The Contractor must send a Plan specific or book of business claimant satisfaction survey, that is mutually agreed upon between the Plan Sponsor and Contractor on an annual basis. The Contractor must report results of the survey to the Plan Sponsor as indicated in the SLAs in Schedule A, Section 10. All areas where claimant satisfaction levels are low must be remedied by the Contractor within a timeframe acceptable to the Plan Sponsor. Sample sizes of responses must be sufficient to produce statistically valid results.

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Bidder must describe what types of measurement tools are used (e.g. satisfaction surveys etc.) to assess customer satisfaction and quality assurance:

Bidder must describe Bidder’s methodologies to solicit feedback about services rendered by Bidder, and how does Bidder monitor and track complaints?

What have Bidder’s satisfaction rates been for the last 3 years?

How often are these tools performed?

Are they performed by internal or external sources?

How are clients notified of their results?

1.5 Enrollment, Eligibility, and Data Interface

1.5.1 The Plan Sponsor is responsible for transmitting eligibility and enrollment information for covered State employees.

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1.5.2 The Contractor must maintain a system for enrollment and eligibility and be prepared to accept, and coordinate, one or more data files from the Plan Sponsor, as indicated in Schedule F - File Layout.

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1.5.3 Data for employees will be supplied through the Human Resource Management Network (HRMN). Eligibility information will be transferred, by the Plan Sponsor, via File Transfer Service (FTS) (or another method selected by the State). The State sends a full eligibility and demographic file on a weekly basis.

The Contractor must maintain and update their enrollment system based on weekly eligibility files received by the State.

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1.5.4 The State requires use of its FTS (or another method selected by the State) for all file transmissions. Electronic transmission of identifiable data must be protected by passwords and a Secure File Transfer Protocol (SFTP) method. The Contractor must develop protocols for electronic data transfer that are consistent with the State of Michigan requirements to ensure data security; see also Schedule A, Section 2 Specific Standards and Schedule E Data Security Requirements. The Contractor must also interface with the Workers Compensation third party administrator.

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1.5.5 The Contractor must accept, load, store and maintain employee demographic and eligibility as transmitted on the weekly file(s).

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1.5.6 The eligibility files must be accepted and utilized for claim management and employee eligibility and/or enrollment update completed, upon notification from the Plan Sponsor or its designee.

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1.5.7 Upon written or verbal notification by authorized Plan Sponsor representatives, employee eligibility and/or enrollment updates must be completed in real-time by the Contractor.

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1.5.8 The Contractor must have accessible and experienced information technology professionals to provide timely programming who are capable and authorized to implement system changes and produce reports.

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1.5.9 The Contractor must use a forced TLS secured connection between the State’s email servers and theirs as an additional layer of protection for all administrative communications concerning individual participants.

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1.5.10 Contractor is responsible for any changes, and any associated costs therein, to their systems or processes required to support the receipt and processing of State of Michigan files. Electronic protocols for electronic data transfer must be consistent with Schedule E Data Security Requirements. See also Schedule A, Section 2. Specific Standards. The Contractor must work with the Plan Sponsor to develop a timeline for implementation and testing of any system/Software changes. The Contractor must maintain a testing environment for such purposes. See also Schedule A Section 5.2.1 Implementation Plan.

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1.5.11 Within 5 business days of verbal or written notice to the Contractor of the need for such information, the State of Michigan must receive all paper and electronic files and have electronic and paper access to any and all files maintained by the Contractor. All requests for such information must be provided through the State’s Program Manager. The Contractor must comply with all legislated medical information privacy requirements.

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1.5.12 The Contractor must allow Plan Sponsor, or Plan Sponsor's consultant, the right to review the internal testing completed for Plan Sponsor's LTD plan, if applicable, prior to the effective date of the plans on an annual basis.

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1.5.13 All records passed from the Plan Sponsor to the Contractor must be uploaded within one business day in the order required by the Plan Sponsor. The Contractor must have validation edits in place to ensure, for each data load, that all fields transmitted are properly uploaded, read, and populated in their system.

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1.5.14 All hard copy and electronic claim files, data and documentation associated with all claim files is the property of the State of Michigan. See also Hybrid Contract Terms, Section 36.

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1.6 Claims Processing

1.6.1 Turnaround Times

1.6.1.1 The Contractor must provide Claims processing services on an accurate and timely basis. See also SLAs in Schedule A, Section 10.

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Bidder must describe Bidder’s claims processing procedures and edits that are applied when claims are opened, pended or denied:

How often are open claims reviewed and by whom and describe your process of identifying and reviewing claims:

1.6.2 Claims Intake

1.6.2.1 The Contractor must be able to receive claims by any method, including telephone (toll-free), facsimile (fax), e-mail, regular mail delivery, electronic data transfer, and web-based claim services. The Contractor must implement any of these claim-reporting methodologies upon request.

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1.6.3 Claim Investigation

1.6.3.1 All LTD claims require contact with the claimant and the designated employer contact be initiated within one business day of receipt of claim by Contractor and documented in the claim file. See also Schedule A, Section 10, SLA#4

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1.6.3.2 The Contractor must document all attempts to contact, and all contacts with the employee, the employer, and the treating provider. The information obtained from these contacts must be accurately documented in the claim file. This information will be the basis for any subsequent decisions relative to the payment or denial of the claim and must be placed in the file within 24 hours of contact.

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1.6.3.3 The Contractor must receive all documents from the claimant and physician as required by the Plan before issuing payment to a claimant including, but not limited to overpayment reimbursement agreement and medical documentation supporting total disability.

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1.6.4 Claim Determination

1.6.4.1 Contractor will make claim compensability determinations within the timeframes specified in Schedule A, Section 10, SLA#5. Contractor was notified of the claim or the date claim documentation is complete, whichever is later.

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1.6.4.2 Claim determination shall be made in accordance with the State of Michigan LTD Plan.

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Bidder must explain how they will ensure that determinations are in accordance with the LTD Plan and meet all other quality related expectations:

1.6.4.3 Claims involving serious complexity or high potential for subrogation and recovery, will require additional review by Contractor’s claims management to collectively identify issues and obstacles and develop a strategic plan of action and document the review in the claim file.

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1.6.4.4 Contractor must have a process to ensure disability determination decisions are appropriately made with sufficient supporting medical documentation.

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Bidder must describe steps taken to ensure disability determination decision are appropriately made and include details regarding complex claims:

1.6.4.5 The Contractor must require a signed agreement to withdraw funds from a Claimant’s bank account to collect any retroactive lump sum Social Security Disability Insurance (SSDI) award.

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1.6.4.6 Contractor must have a process to notify claimants of pended claims, claim approval and denials.

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Bidder must explain how claimants are notified of pended claims, claim approval and denials:

1.6.4.7 Contractor must have a process to monitor, track, and report claims.

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Bidder must explain how cases are monitored, tracked and reported:

1.6.4.8 Contractor must have a process for conducting surveillance where appropriate and with the concurrence of Plan Sponsor.

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Bidder must explain their process:

1.6.4.9 Contractor must have a process to manage return to work with or without restrictions.

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Bidder must explain how this information captured and used, if the claimant is able to return to work with restrictions or if the employer makes alternate duty, transitional temporary work available:

1.6.4.10 The Contractor must have a process in place to confirm a claimant returned to work on the date indicated on the medical documentation within the claim.

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Bidder must explain their process:

1.6.5 Claim File Documentation

1.6.5.1 All files must be documented in a logical searchable manner that allows a reviewer the ability to quickly review all claim activity and determine the current status of a claim. Files must also be documented in a consistent manner with all pertinent material related to the claim and such documentation shall be current in the file from receipt by the Contractor.

1.6.5.1.1 Claim files must be separated to reflect the distinct aspects of the claim. Examples include but are not limited to medical documentation, legal notices, litigation correspondence, payment information, claim notes, forms required by the State of Michigan Long Term Disability Plan etc.

1.6.5.1.2 Claim examiner notes must be current and maintained electronically in a current and accurate manner. At a minimum, claim file notes must contain but not be limited to, statement of coverage, detailed and comprehensive summary of all telephone conversations, attempted telephone contacts and any contacts connected to the claim, summary of investigations, claim determination and rationale, subrogation potential, summary of medical received, plan of action (including current summary of claim, medical status, proactive action based strategy, and anticipated date of claim resolution), claim overpayment documentation, disputes, claim appeal information and any documentation connected to the claim.

1.6.5.1.3 All claim files and information must be securely retained by the Contractor for the life of this contract. Upon expiration or termination of this contract, all claim files and related information must be returned to the State of Michigan or its designated representative in electronic form. Any paper records that exist must be converted to electronic form.

1.6.5.1.4 Withing two business days of request of Plan Sponsor all claim records including notes, documents and payment records must be provided to Plan Sponsor electronically and in a searchable format.

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Bidder must provide a sample claim file and submit with proposal:

1.6.6 Claim Payments

1.6.6.1 Unless otherwise determined by the State of Michigan, the Contractor is responsible for processing all claim payments to eligible State employees.

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1.6.6.2 The Contractor must provide claim payments accurately. See also SLAs in Schedule A, Section 10.

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1.6.6.3 All claims, payments and associated claim expenses shall be recorded as associated with the individual claim.

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1.6.6.4 Claim payments are to be made bi-weekly for claims up to six months old and monthly for those claims over six months.

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1.6.6.5 All claim payments must be to eligible employees and made in accordance with requirements as provided in the Long Term Disability Benefits Plan as specified in the LTD Plan Booklet (Refer to link in Schedule A, Section 1.2.1) as may be amended or in procedures and regulations established by the State of Michigan along with proper documentation and notice to all relevant parties.

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1.6.6.6 The Contractor must only charge against the Plan Sponsor’s account claim payments authorized under the Plan Sponsor’s Plan Design. If it is determined that claims have been improperly paid, the Plan Sponsor will be reimbursed for the cost of improper payment. In the event of an overpayment, Contractor will immediately notify the State Program Manager and claimant and document in the claim file the reason for the overpayment, amount of the overpayment and plan of action for recovery.

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1.6.6.7 The State of Michigan will not be responsible for overpayments on claims resulting from error within the scope of Contractor’s control. Any overpayment resulting from error within the scope of Contractor’s control is the responsibility of the Contractor. Contractor will immediately credit the State of Michigan in full amount of the overpayment and apply the credit directly to the affected claim. Recovery of avoidable overpayments directly from the Claimant or through benefit adjustments are limited to 6 months prior from the date of discovery. Additional recovery impacting a claimant may be made only with the agreement of the Plan Sponsor.

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1.6.6.8 The Contractor must have a claims processing team that is experienced in handling recoveries.

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1.6.6.9 Contractor must have an overpayment process to minimize overpayment occurrence and maximize overpayment recovery. Implementation of this process will require approval from the Program Manager. The Program Manager reserves the right to require changes to the Contractor’s overpayment process in the event the Program Manager finds the process ineffective.

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Bidder must explain overpayment process, and also: what procedures are in place to assure timely and accurate coordination of supplements and offsets (e.g., Workers’ Compensation, SSDI, Unemployment Benefits etc.):

1.6.6.10 Benefit payments to claimants can be made by EFT or by check. All claim benefit checks issued by the Contractor must include expiration statement of 180 days from the date it was issued if not cashed by recipient within that period of time.

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1.6.6.11 Contractor must continuously review all claims to determine whether a claimant will be asked to apply for SSDI. Once Contractor identifies those claims which appear to fit the SSDI criteria, those individuals must be advised to apply for SSDI.

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Bidder must explain their process, including but not limited to:

1)After what length of disability does Bidder have claimants apply for SSDI benefits?

2) Does Bidder use a subcontractor to provide SSDI application assistance to Claimants? If so, please ensure explanation included in process:

1.6.7 Claim Dispute Resolution

1.6.7.1 The Contractor must undertake responsibility for providing Determinations on behalf of Plan Sponsor, including full and fair review of claims appeals by Claimants that have been denied either in full or in part. The Contractor’s claims appeals process must comply with the Plan Sponsor’s claims appeals process as stated in “Michigan Civil Service Commission Regulation 5.18” at https://www.michigan.gov/documents/Regulation_5_128248_7.18.pdf . The Contractor’s claims appeals reporting must comply with Plan Sponsor’s claims appeals reporting requirements.

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1.6.7.2 There are three levels to the appeal process. The first level appeal request is with the Contractor. The Contractor will conduct a thorough and timely review for each appeal request. The Level I appeal with the Contractor will be required to have a committee review and recommend a decision. Appeal Levels II, and III are with the State of Michigan. There should be enough information in the Contractor’s appeal decision and in the claim file to assist all appeal levels in reaching a decision. The Contractor’s appeal review process must be approved by the Program Manager.

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1.6.7.3 The Contractor must have processes in place to detect, prevent, and correct fraud, waste, and abuse. Where fraud or abuse is discovered, the Contractor must reimburse the Plan Sponsor and attempt to make recoveries when applicable. Detected fraud, waste or abuse must be reported to the Plan Sponsor immediately with any and all relevant evidence to substantiate the detection of such fraudulent activity and must be remedied in conjunction with the monthly reporting schedule in Schedule A, Section 5.4 Reporting.

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1.6.7.4 Data collected on behalf of the State is not to be distributed to any party without the written consent of the State. Except for such use solely limited for the purpose of providing Contract Activities, State Data is not to be used by the Contractor for any purpose without express, written approval by the State.

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1.6.7.5 System rules or programming errors that result in improper payment of claims or payment of claims to ineligible participants will be considered financial errors.

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1.7 Medical Case Management

1.7.1 Contractor must perform internal medical case review and obtain Independent Medical Evaluations from healthcare providers qualified to evaluate the medical condition where appropriate.

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1.7.2 A medical consultant or medical case manager, defined as an employee with a relevant clinical background in nursing or medicine (RN or MD), must be utilized for claim review when there are reasonable questions about total disability.

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How is your current medical case management process initiated? Bidder Response:

1.7.2 At a minimum, the Contractor may request Independent Medical Evaluations (IME) in the follow circumstances:

· The treating physician is not cooperating or not facilitating communication.

· There is a question of disability.

· There are only subjective complaints.

· There is a question of how a physician is handling a case.

· There is a need to substantiate medical findings.

Reasoning for the IME referral must be documented in the claim notes.

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1.7.3 All physicians selected must be board certified and be of equal or greater credential in the relevant specialty appropriate for the medical certification to be evaluated, and be physically located within a reasonable distance from Claimant's residence. Criteria and continued evaluation process of IME doctors used must be provided to the Program Manager for approval.

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Bidder must provide their process for selecting IME physicians and their qualifications, including but not limited to:

· What is your current selection criteria for IME doctors, and how do you measure their performance?

· What protocols are in place to ensure that the most appropriate doctor is selected for the IME?

· Do you have negotiated rates with your IME vendors? If yes, please explain the arrangement here, and indicate Michigan rate ranges within Schedule B, Pricing.

1.8.1.1 The Plan Sponsor intends to periodically (at least once every two years) perform an audit of the Contractor either on-site or remotely at the discretion of the Plan Sponsor. The Plan Sponsor’s current approach has been to audit two Plan Years at one time, conducted within 12 months of the end of the second year audited. The Plan Sponsor reserves the right to change this approach without prior notice.

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1.8.1.2 The Contractor must make records associated with the administration of the State’s plans available to, and must cooperate with, such auditors and audits as the Plan Sponsor may designate.

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1.8.1.3 Contractor must maintain and make available to the State’s auditors the following claim source documents for the audit:

· Paper claim submission – Original document or microfilm or print-out of imaged claim document.

· Optical Character Recognition (OCR) – Copy of original paper document.

· Electronic Data Interchange (EDI) – Documentation in a readable format of original submitted data as it appeared when received by administrator.

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1.8.1.4 The Contractor agrees to not impose limitations on the number of claims to be audited and no additional charges to Plan Sponsor for audits, including, but not limited to, onsite pre-implementation audit, annual claims audit and annual benefit audit, etc.

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1.8.1.5 The Contractor must provide any requested data elements required to complete a benefit and claims audit 30 days from receipt of the data request by the Plan Sponsor’s auditor.

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1.8.1.6 The Contractor must provide their responses to the claims that require review within 30 days of receipt of claim inquires and/or exceptions from the Plan Sponsor’s auditor.

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1.8.1.7 If necessary, the Contractor and the State will meet to review each audit report after issuance. The Contractor must respond to each audit report in writing within 30 days from receipt of the report, unless a shorter response time is specified in the report.