Affiliated Provider auditsTo make sure Affiliated Providers (APs) are complying with the terms of their AP agreements, audits are regularly undertaken by Southern Cross.
The annual audit schedule is set annually and indicates which specialties will be audited and when. Please note, you will only be audited on the rights and obligations under your AP agreement. An AP may be asked to participate in two types of audits.
Standard audit: This involves auditing compliance with an AP agreement and will originate from the annual audit plan.
Follow-up and ad hoc audits: These take place when we have identified irregularities or possible AP agreement breaches in a standard audit, or as a result of data analysis or other investigations. These audits may also be essential to confirm that required changes have been put in place after a standard audit or as a means to establish whether an issue is systemic.
ENT - adenoids and grommets
Cardiology - CTCA
|General surgery - cholecystectomy||
Ophthalmology - cataracts and related procedures
|Medical - radioactive iodine||
General surgery - skin GA procedures
|General surgery - gastric banding/bypass|
|Urology - prostate laparoscopy|
|ENT - balloon sinuplasty (deferred)|
Notice of an audit
Affiliated Providers (APs) will be given no fewer than five working days’ notice of an audit. However, if the audit's integrity is at risk of breach or a serious specific incident has occurred, APs will be given 24 hours' notice.
Audit results are kept confidential between you and Southern Cross. Identifiable personal information will not be recorded in audit reports.
Please direct any questions to firstname.lastname@example.org or call the Provider line on 0800 770 843.