P.R. Laws tit. 26, § 9084
This chapter shall apply to all health insurance organizations or issuers. The provider accepting assignment of benefits of a covered person or enrollee shall be responsible for the billing process and the results of the claim audits whether conducted by an employee or by contract with another firm. The provider and health insurance organization or issuer shall:
(a) Supervise the process to ensure that the audit is conducted in accordance with the requirements of this chapter;
(b) be aware of the actions being undertaken by the auditor in connection with the claim audit, and
(c) take prompt remedial action if inappropriate behavior by the auditor, the provider, or the person he/she designates as audit coordinator is discovered.
History —Aug. 29, 2011, No. 194, § 6.040, eff. 180 days after Aug. 29, 2011; July 10, 2013, No. 55, § 6, eff. 30 days after July 10, 2013.