HCRA Compliance Reviews
Provider Milestones and Timelines for Review of Three Years
Timeline | Phase | Description | Reviewee Responsibilities |
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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. |
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Day 11 Day 22 Day 33 |
Pre-fieldwork Planning | KPMG will schedule the kick-off and data pull conference calls. The kick-off conference call is held to describe the process of the review and the data pull conference call details what data fields KPMG is requesting. |
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Day 40 | Questionnaire Submission | Reviewee´s completed questionnaire is due to KPMG |
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Day 45 - 50 | Entrance Conference/ Data Receipt/ Fieldwork Begins | On Day 45, an entrance conference will be held, and the first years´ worth of data is due. Fieldwork begins on Day 45, and KPMG will be on-site at this time conducting interviews and reviewing documentation. 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 55. |
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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 |
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Day 65 | Fieldwork - Resolution of Data Issues | KPMG will resolve data follow-up questions and confirm if alternative procedures are required. Testing commences at this point. |
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Day 85 | Payor Determinations Provided to Reviewee | KPMG will conduct a name to name match with the claims data to the DOH electing Payor list. KPMG will identify the direct and non-direct payors. KPMG´s determinations will be provided to the reviewee for review. |
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Day 90 | Preliminary Review Payor Determination Responses | The reviewee will provide preliminary supporting documentation to KPMG. |
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Day 95 | Preliminary Determination of Acceptable Supporting Evidence | KPMG and DOH discuss the supporting documentation provided by the reviewee to determine if it is acceptable. | N/A |
Day 105 | Responses to Payor Determinations are due to KPMG | Reviewee responses and supporting documentation are due to KPMG. KPMG to review responses and discuss with DOH. |
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Day 125 | Testing Results Sent to Reviewee | KPMG will send test results to the reviewee for their review and response. KPMG, DOH, and the reviewee will hold a conference call to discuss the draft findings and next steps. |
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Day 130 | Preliminary Results Meeting | A conference call between the reviewee, DOH and KPMG is held to discuss KPMG´s preliminary test results. |
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Day 135 | Preliminary Review Response | The reviewee will provide supporting documentation to KPMG. |
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Day 140 | Preliminary Determination of Acceptable Supporting Evidence | KPMG and DOH discuss the supporting documentation provided by the reviewee to determine if it is acceptable. | N/A |
Day 150 | Responses to Test Results are due to KPMG | Reviewee responses and supporting documentation are due to KPMG. KPMG to review responses and discuss with DOH. |
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Day 160 | Review of Preliminary Results Response with DOH | KPMG reviews the supporting documentation provided by the reviewee and discusses with DOH. | N/A |
Day 170 | Data Exceptions Conference | KPMG, the reviewee, and DOH will engage in a conference call to discuss outstanding issues. The reviewee will be notified of the outcome of the response review, and will be given next steps. It should be noted that, once this process has been completed, the results of the testing are final. |
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Day 195 | DOH Reviews Draft Report | KPMG to submit the draft report to DOH. DOH to have ten business days for report review. | N/A |
Day 205 | KPMG Draft Report Revisions | DOH report comments due to KPMG. | N/A |
Day 209 | DOH Approves Draft Report | KPMG updates the draft report based on DOH´s comments and DOH approves the draft report to be sent out to the reviewee. | N/A |
Day 210 | Formal Response to Report | KPMG to send final 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. |
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Day 215 | Exit Conference | A conference call is held between the reviewee, DOH, and KPMG to discuss the final report. |
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Day 225 | KPMG Response to Report | Reviewee´s formal response due to KPMG. KPMG to respond as necessary. |
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Day 235 | Final Report | KPMG to submit final report with reviewee responses attached. | N/A |