HCRA Compliance Reviews
Payor Milestones and Timelines for Review of Six Years
Timeline | Phase | Description | Reviewee Responsibilities |
---|---|---|---|
Day 1 | Reviewee Notification, Review Kick-off | KPMG LLP (KPMG) sends letter, questionnaire, and data requests to Reviewee. The Reviewee will have 44 business days to compile data requests, ask questions, and prepare documentation. KPMG will schedule on site time for the entrance conference. |
|
Day 11 Day 22 Day 33 |
Pre-fieldwork Planning | KPMG will schedule a series of status calls and/or on-site visits with the Reviewee to discuss:
|
|
Day 40 | Questionnaire Submission | Reviewee´s completed questionnaire is due to KPMG |
|
Day 45 - Day 70 | Entrance Conference/ Data Receipt/ Fieldwork Begins | On Day 45, an entrance conference will be held, and at least one years' worth of data is due. The additional years will be due incrementally in each of the following weeks. The last day to submit requested data and documentation to KPMG is Day 70. Fieldwork begins on Day 45, and KPMG will be on site at this time conducting interviews and reviewing documentation. |
|
Day 45 | Data and Information Request Representation Letter Due | Letter indicating that all documentation and data provided to this point is complete, accurate, and in accordance with the instructions in KPMG´s questionnaire |
|
Day 80 | Fieldwork - Resolution of Data Issues | KPMG will resolve data follow-up questions and confirm if alternative procedures are required. Testing commences at this point. |
|
Day 125 | Testing Results Sent to Reviewee | KPMG will send the Preliminary Results Packet to the Reviewee for their review and response. KPMG and the Reviewee will have a meeting to briefly discuss the preliminary findings and next steps. The Reviewee will have 45 business days to formulate and document their response to KPMG´s results. |
|
Day 130 | Preliminary Results Meeting | DOH, KPMG, and Reviewee will have a meeting to discuss preliminary findings and next steps. |
|
Day 135 | Preliminary Review of Responses to Test Results | On Day 135, a meeting will be held with KPMG, DOH, and the Reviewee to discuss sample(s) of supporting evidence prepared by the Reviewee to clear KPMG´s preliminary results. |
|
Day 140 | Preliminary Determination of Acceptable Supporting Evidence | KPMG and DOH will meet to discuss the sample(s) of supporting evidence. DOH will determine whether the supporting evidence is acceptable. |
|
Day 145 | Communicate Preliminary Determination to Reviewee | KPMG, DOH, and the Reviewee will have a meeting to communicate DOH´s preliminary determination of whether sample(s) of supporting evidence provided on Day 135 is acceptable. |
|
Day 155 | Preliminary Review of Responses to Test Results | On Day 155, a second meeting will be held with KPMG, DOH, and the Reviewee to discuss sample(s) of supporting evidence prepared by the Reviewee to clear KPMG´s preliminary results. |
|
Day 160 | Preliminary Determination of Acceptable Supporting Evidence | KPMG and DOH will meet to discuss the sample(s) of supporting evidence. DOH will determine whether the supporting evidence is acceptable. |
|
Day 165 | Communicate Preliminary Determination to Reviewee | KPMG, DOH, and the Reviewee will engage in a conference call to communicate DOH´s preliminary determination of whether sample(s) of supporting evidence provided on Day 155 is acceptable. |
|
Day 170 | Responses to Test Results are due to KPMG | Reviewee responses and supporting documentation are due to KPMG. |
|
Day 185 | Review of Preliminary Results Response with DOH | KPMG will review responses and supporting documentation with DOH during the Review of Preliminary Results Response Meeting. | N/A |
Day 200 | Data Exceptions Conference | KPMG, the Reviewee, and DOH will engage in a conference call to discuss final results of testing. The Reviewee will be notified of the outcome of the response review, and will be given next steps. It should be noted the results of testing are final. |
|
Day 205 | Extrapolation Process | To the extent a statistical sample is used, KPMG will send the results of testing to its statistician for extrapolation. | N/A |
Day 230 | DOH Reviews Draft Report | KPMG to submit the draft report to DOH. DOH to have 10 business days for report review. | N/A |
Day 240 | KPMG Draft Report Revisions | DOH comments on report due to KPMG. | N/A |
Day 244 | DOH Approves Draft Report | KPMG to provide revised draft report to DOH for final approval prior to delivery to the Reviewee. | N/A |
Day 245 | Formal Response to Report | KPMG to send draft report to Reviewee for their formal response. The Reviewee to have 15 business days to formally respond to KPMG´s report, which will be included as part of the final report. |
|
Day 250 | Exit Conference | KPMG, the Reviewee, and DOH will engage in a conference call to discuss the report. |
|
Day 260 | KPMG Response to Report | Reviewee´s formal response due to KPMG |
|
Day 270 | Final Report | KPMG to submit final report with Reviewee responses attached. | N/A |