SOP & Policy Center
Central repository for all Fraud, Waste and Abuse documentation
SOP: FWA Detection Procedure
DetectionUpdated: 2023-11-15
Outlines steps to identify and log fraud/waste cases during claim intake.
PDF • 2.4 MB
SOP: Escalation Handling
ProcessUpdated: 2023-09-28
Defines how flagged cases are escalated to compliance or legal.
Word • 1.8 MB
Policy: Audit Governance Manual
ComplianceUpdated: 2023-10-05
Details internal auditing, documentation, and traceability requirements.
PDF • 3.1 MB
Playbook: Stakeholder Roles
GovernanceUpdated: 2023-08-17
Maps CHI, TPAs, and Providers' responsibilities across the FWA chain.
PDF • 2.7 MB