Dependent Eligibility Verification Audit (DEVA) Services

Vendor shall provide all labor, technology, communications, call center support, document management, reporting, and project management necessary to complete a full medical DEVA, including without limitation:
1. Project kickoff with District HR/Benefits, the medical TPA (UMR), and Gehring Group; confirm medical eligibility rules, populations, data feeds, and communication approvals.
2. Receive and securely process District medical enrollment/eligibility files (and refresh files as agreed).
3. Prepare and send customized project announcement(s) and detailed audit instructions to all Enrollees in scope (content subject to District approval).
4. Multi-channel employee communications (mail and/or email, and optional SMS/voicemail as proposed) with a documented cadence of touchpoints.
5. Secure collection, review, and storage of eligibility documentation for each medical Dependent.
6. Employee affidavit / attestation component
7. Web portal available 24/7 during the audit response window, plus mobile-friendly document upload.
8. U.S.-based (or clearly disclosed) call center support for Enrollees throughout the Audit and Appeal Period.
9. Follow-up with Enrollees who submit incomplete or insufficient documentation.
10. Objective eligibility determinations against District medical plan rules in Section 4 (including spouse/DP other-employer 80% contribution rule); exception tracking with rationale.
11. Structured appeals / reinstatement process with defined timelines.
12. Weekly (or more frequent) status reporting and dashboards during the project; final results report and executive presentation.
13. Secure transmission of medical termination/reinstatement files to the District and/or medical TPA in agreed formats and timelines.
14. Document retention and destruction schedule compliant with HIPAA and District records requirements.
15. HIPAA Business Associate Agreement (BAA) with the District (and subcontractors as required).