P.R. Laws tit. 26, § 9087
(a) Providers shall designate an individual to coordinate all claim audit activities. An audit coordinator shall have the same qualifications as required for an auditor pursuant to § 9085 of this title. The duties of an audit coordinator include, among others, the following:
(1) Scheduling an audit to be carried out during business hours;
(2) advising other provider personnel and departments of a pending audit;
(3) ensuring that the condition of admission statement is part of the clinical record;
(4) verifying that the auditor is an authorized representative of the health insurance organization or issuer;
(5) gathering the necessary documents for the audit;
(6) coordinating auditor requests for information, space in which to conduct an audit, and access to records and provider personnel;
(7) orienting auditors with respect to the provider’s audit procedures, record documentation conventions, and billing practices;
(8) acting as a liaison between the auditor and other personnel of the provider;
(9) conducting an exit interview with the auditor to answer questions and review audit findings;
(10) reviewing the auditor’s final written report and following up on any charges still in dispute;
(11) arranging for payment as applicable, and
(12) arranging for any required adjustment to bills or refunds.
History —Aug. 29, 2011, No. 194, § 6.070, eff. 180 days after Aug. 29, 2011; July 10, 2013, No. 55, § 9, eff. 30 days after July 10, 2013.