Monthly Audits on Demand Subscription Form

STEP 1 : Complete Request Form

Please complete this form to include all Audits to be completed monthly.

Audits on Demand Monthly Subscription

Organization Name*

Audit Point of Contact : Name*

Audit Point of Contact : Phone*

Audit Point of Contact : Email*

Please add a new Audit for each monthly Audit to be completed by the Data Management Solutions Team. If additional Audits are needed, click the gray "+ADD NEW AUDIT" button for each new Audit.

STEP 2 : Upload Data

Upon submission of this form, please send any applicable data files via secure email to support@dms-datavalidate.com. All files should be in an Excel format.

STEP 3 : Initial Contact

Upon receipt of the Request form and data, a member of our Data Management Solutions Team will review and schedule a time to ask additional questions to assist us with setting up the overall implementation of your audit workflow and organization/client-specific structure onto the platform.

STEP 4 : Implementation / Implementation Overview

Within 3-5 business days of the initial contact, our Team will complete the following:

Audit Workflow mapping and template set up
Provide DVP Access
Complete Initial Audits
Send Audit Results Ready Email confirmation
Schedule training on retrieving results from the Data Validation Platform

STEP 5 : Monthly Recurring Audits Begin

DMS Team initiates request for Audit Data in conjunction with the date invoices are available.
Client uploads Audit Data to DMS Team
DMS Team completes Audit
Client/Org notified when Audit results are available

Pricing / Billing

Select an Audit Plan:*

Monthly Invoice Reconciliation Audit : $40 per Carrier Audit per month

Monthly Invoice Reconciliation & Quarterly Census Audit : $55 per Carrier Audit per month

Billing Contact : Name*

Billing Contact : Email*

Billing Contact : Phone*

Terms & Service Agreement

Terms & Conditions

Audit Services Start Date*

By checking this box I agree that the term of the selected audit services shall begin on the date this form is signed (the effective date) and shall continue in full force and effect for a term of one (1) year, provided that the Term shall automatically renew for successive one-year periods unless either Data Management Solutions- Data Validation Platform, LLC or the client sends written notice to the other of its intent to terminate this agreement at least 60 days before the day the Term would otherwise expire.

Yes, I agree

Payment Acknowledgement:*

I further agree that during the term of this Agreement, I , the client shall pay Data Management Solutions- Data Validation Platform, LLC for its Services under this Agreement based on the fee that corresponds with my selected audit plan.

Yes, I agree

Invoice Acknowledgement : *

I understand that I will be invoiced on the first of the month for all applicable implementation fees and audit services fee and that invoices are due upon receipt.

Yes, I agree

Acknowledgement of Terms & Service Level Agreement

Acknowledgement of Terms & Service Level Agreement*

By checking this box I acknowledge and verify that I have read and agree to the Audit Services Level Agreement document located here.

Yes, I agree

Signature to accept Terms & Conditions*

Your Full Name

Your Title

Date & Time*

Select Date ×

Monthly Audit on Demand Subscription Form

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STEP 1 : Complete Request Form

Audits on Demand Monthly Subscription

Please add a new Audit for each monthly Audit to be completed by the Data Management Solutions Team. If additional Audits are needed, click the gray "+ADD NEW AUDIT" button for each new Audit.

STEP 2 : Upload Data

STEP 3 : Initial Contact

STEP 4 : Implementation / Implementation Overview

STEP 5 : Monthly Recurring Audits Begin

Pricing / Billing

Terms & Service Agreement

Acknowledgement of Terms & Service Level Agreement

Your form has been submitted