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R2006-137 AUTHORIZING AGREEMENT
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R2006-137 AUTHORIZING AGREEMENT
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Last modified
11/2/2015 2:33:14 PM
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11/2/2015 2:33:13 PM
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Resolution/Ordinance
Res Ord Num
R2006-137
Res Ord Title
AUTHORIZING AGREEMENT HEALTH PLAN CONSULTANT REVIEW - THE SEGAL COMPANY
Approved Date
9/5/2006
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� The Honorable Paul Osborne I <br /> � City of Decatur �, <br /> August 30, 2006 ' <br /> Page 9 ' <br /> etc.) which are beyond Segal's control. Our bi-weekly status reports will keep you informed on our <br /> project status. <br /> We will provide our draft repoR to Consociate Dansig approximately 10 to 15 days after the onsite <br /> audit for review and comment prior to presenting our final report (including a copy of their <br /> response) to the City. We believe this practice promotes a constructive process by all parties, <br /> allowing Consociate Dansig an opportunity to explain their position and identify corrective action <br /> that has or will be taken. The location and time for report presentation will be mutually determined <br /> upon completion (12 to 16 weeks from award of contract). <br /> Sampling Methodology and Audit Sample Size <br /> Sample size and methodology have a direct impact on costs. Therefore, it is imperative that we <br /> identify whether the audit objective is to confirm financial accuracy or obtain a general level of <br /> confidence in overall processing accuracy. <br /> In general, a larger sample size will give greater statistical validity to the results of the audit. If the <br /> goal of the audit is to obtain a sample of claims that are representative of all claims, then a larger <br /> sample size would be essential. In other words, if the City's goal is to have a high level of <br /> confidence regarding the overall financial impact of the audit and to have financial statistical <br /> validity, we would recommend a stratified selection of claims. <br /> However, if the primary goal of the audit is to focus on particular types of claims (for certain types <br /> of services or within certain plans) then we can select a targeted sample of claims. This process <br /> will examine only those claims that represent specific problem areas. A targeted selection of <br /> claims, however,does not offer statistical validity and is by design not representative of all claims. <br /> We recommend a stratified selection of claims from the most recent 12-month period (i.e., <br /> September 1, 2005 through August 31, 2006) that will yield a level of confidence in the overall <br /> financial impact of our audit findings. In addition, we will select 15 zero payment claims to ensure <br /> accuracy of deductible application and claim denial. Zero pay claims are classified in a separate <br /> stratum and factored into the statistical calculations for overall and procedural accuracy. Should the <br /> population of zero payment claims require more than 15 samples to maintain statistical confidence, <br /> these claims will be treated as a target sample and eliminated from the statistical calculations. <br /> The following table shows statistical confidence factors and fees for several options. We can <br /> prepare estimates for additional options at the City's request. <br />
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