Delegate Auditing & FDRs

ATTAC Consulting Group provides solutions plans need for delegate oversight and compliance monitoring, including providing FDR auditing and outsourced audit solutions.

CMS, CCIIO, Medicaid agencies, insurance and health departments hold plans accountable for the performance and compliance of their delegates, first-tier, downstream and related entities (FDRs) for services they delegate. Our solutions are designed to make this a win-win for the plan and its FDRs.

ATTAC provides plan solutions for monitoring, auditing and oversight of FDRs

• Evaluating and sourcing delegate and FDR data for reporting
• Design and implementation of delegate reporting protocols, metrics and SLAs
• Creation of dashboards and key performance metrics
• Design of delegate audit tools and training of plan staff in auditing of Medicare, Medicaid, demos and commercial delegates

ATTAC conducts delegate auditing, including an out-sourced auditing for:

• • Outsourced Enrollment Operations

  • Outsourced / Delegated Claims Operations
  • Delegated Credentialing for IPAs and Medical Groups
  • Delegated UM and Organization Determinations for IPAs and Medical Groups

  • Delegated Model of Care and HRA Administration

• Pharmacy Benefit Managers (PBMs)
• Field Marketing Organizations (FMOs) and Sales Agents
• Fulfillment Operations
• Dental and Vision Sub-Contractors

To enhance the reach of your staff to conduct compliance and performance audits, ATTAC Consulting Group can also perform routine audits of your delegates on your behalf. It’s a cost-effective solution to enhance your oversight program.

Learn about ATTAC’s operations and compliance solutions for FDRs