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RETURNS & DISPUTES POLICY JULY 2020

Updated: May 19, 2021

The following is an update and reminder of Cal Audits policy in handling jobs returned for corrections from our review department, and job disputes that have been sent back from our carriers to have corrections made. There are also new guidelines when these rules are not followed, and how these jobs will then be handled.   Job Returns: When a job is returned from the Cal Audit Review Dept. for correction(s) to be done - 

  • The auditor is to complete the corrections and return to the office in a 48 hour window. 

  • If the corrections can't be made with in the 48 hours due to any reason, a progress note must be made as to why and what action is being taken, i.e. insured called, emailed, sending more information or records, etc. 

  • If delays for the correction continue, then the job needs to have updated progress notes at least once a week, if not more, until the job is re-submitted with the corrections made. 

  • New - Jobs with corrections can't sit idle for more than 5 days with no action taken i.e. not re-submitted or no progress notes. Idle jobs will be removed at that time from the rep. and assigned to another auditor, due to lack of progress. 

Job Disputes: When a job is returned from a carrier with questions or corrections needed. 

  • A deadline is set with the date of when the job is to be returned.  The date is on the email sent by Doni or Support.  Generally, the time frame is 2 weeks to make the corrections and then re-submit the job.  

  • If the corrections can't be made within the 2 weeks (or the time frame given) due to any reason, a progress note must be added, stating why and what action is being taken, i.e. insured called, emailed, sending more information or records, etc.

  • If delays for the correction continue, then the job needs to have updated progress notes at least once a week, if not more, until the job is re-submitted with the corrections made. 

  • New - Jobs disputes can't sit idle for more than 2 weeks (or the time frame given) with no action taken i.e. not re-submitted or no progress notes. Jobs are to be worked during these 2 weeks with progress noted. Idle jobs will be removed at that time from the rep. due to lack of progress and assigned to another auditor. 

It should be noted that job(s) removed from an auditor (due to lack of progress) and reassigned to another auditor to make the corrections, on a Return or a Dispute, will have a deduction of time taken from them and given to the new auditor making the corrections. The amount of time will depend on how much time was needed to make the correction.  Notification from the office will be given to auditors prior to job(s) being removed.


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