Vendor Audit Letter Template


Mr/Ms. Vendor Contact Name
Company Name
Company Address
City, State Zip
Dear Mr/Ms.:
As part of our Vendor Management Program, (Name) Health Plan performs oversight of
all functions which have been delegated to
(Vendor Name).
In preparation for this year’s
audit, we are requesting information for the period (Date). This information includes
data from (Claims, Credentialing, Customer Service, Compliance, Finance, Provider
Relations/Network Development, Quality Management, and Utilization Management).
This audit will be handled (remotely, on site); please prepare binders, tabbed by topic. If
applicable, 1) the claims information binders should be separate from all other sections,
2) Medicare information must be provided separately from all other lines of business for
each section. Please create two copies of each binder. The details of the audit are listed
as follows:
The following information is needed for the Claims Audit:
1. A claims run for claims processed for the time period (Date). This should include:
i. Par and non par claims
ii. Clean claims and unclean claims
iii. Denied and paid claims
Please forward to my attention, via CD-Rom, the claims data. (Name) will then
select a sample of 1% of claims processed or a minimum of 50 claims (25
Medicare and 25 Medicaid), which we will send to you via email. After we notify
you of our sample selection, promptly forward to us the following:
a. Hardcopy of the claim (the claim must have vendor’s received date
stamped on the claim)
b. Screen print of the claim from your claims system and the screen print(s)
must contain the following:
Date Claim Received
Date Paid
Check Number


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