Audits on Demand Form

STEP 1 : Request Form

Complete Request Form. If additional Audits are needed, click the gray “+ADD NEW AUDIT” button for each new Audit.

Please note that an additional file manipulation will be applied for any Ancillary and Voluntary carriers with multiple benefits; examples include but are not limited to: Guardian, Unum, Reliance Standard, The Standard, etc.

Audits on Demand

Organization Name*

Audit Point of Contact Name*

Audit Point of Contact Phone*

Phone

Audit Point of Contact Email*

Audit Section : If you do not wish to submit all audits being purchased today, DMS will send you a link to submit future audits at the time of need.

STEP 2 : Upload Data

Upon submission of this form, please send any applicable data files via secure email to support@dms-datavalidate.com, as well as any helpful information or files. Please note an upload user function is coming soon to allow for files to be uploaded directly to the platform.

STEP 3 : We Will Contact You

Upon Receipt of the request form and the data, a member of our audit Team will review and reach out with any clarifying questions.

STEP 4 : Login Details

A login to our Data Validation platform where audit results will be retrieved will be sent to the Audit Contact email.

STEP 5 : Timeframe

Audits will be completed within 3-5 business days from receipt.

STEP 6 : Email Confirmation

An email will be sent to confirm audit completion with instructions on how to access the audit results.

STEP 7 : Questions

Audit on Demand Inquiries should be sent to support@dms-datavalidate.com

Select an Audit Plan

Please select the audit plan option that corresponds to your needs along with the billing option to be used.

Plan	# Audits included	Cost Starting at	Per Audit
Audit 1	1	$139.39	$139.39
Audit 5	5	$499.39	$99.88
Audit 10	10	$749.39	$74.94
Audit 20	20	$999.39	$49.97

Select a Plan*

I understand that an additional data manipulation fee of $139 will be applied for voluntary/ancillary benefit audits for more than one benefit plan. Carriers include but are not limited to Guardian, Unum, USAble, Reliance Standard, The Standard, and Hartford. Example, an AOD 5 Audit plan is selected, 1 of the 5 audits is for a Guardian audit, I will be charged an additional $139 for the Guardian audit. So my cost is $499.39+$139=$638.78.

Audit 1

Audit 5

Audit 10

Audit 20

Pricing / Billing

Billing Contact Name*

Billing Contact Email*

Email Address

Billing Contact Phone*

Phone

Select a Billing Option*

Invoice : I understand and agree that a separate audit invoice will be provided to me on the 1st of the month following receipt of my request due upon receipt.

Credit Card : I understand and agree that the card provided will be billed for my audit plan on the 5th of the month following receipt of my request. Should the 5th of the month not fall on a business day, payment will be executed on the business day immediately prior to the 5th.

Service Agreement

Data Manipulation Fee Acknowledgement*

I understand that an additional data manipulation fee of $139 will be applied for voluntary/ancillary benefit audits for more than one benefit plan. Carriers include but are not limited to Guardian, Unum, USAble, Reliance Standard, The Standard, and Hartford. Example, an AOD 5 Audit plan is selected, 1 of the 5 audits is for a Guardian audit, I will be charged an additional $139 for the Guardian audit. So my cost is $499.39+$139=$638.78.

Yes, I agree

Audit Terms : Unused Audits*

I understand that I will not be reimbursed for unused audits. The number of on demand audits in my package must be used within a three (3) months of the date requested.

Yes, I agree

Audit Terms : Audit Results*

I understand that I will be required to retrieve all audit results via my secure login to the Data Validation Platform unless otherwise specified by a member of the Data Management Solutions audit team.

Yes, I agree

Assurance : Authorized User*

By signing the below, I as the customer, certify I am an authorized user of the credit card provided and as such, there will be no disputed for these scheduled transactions with the bank or credit card company; so long as the transactions correspond to the terms indicated in this subscription form. In addition, as the customer, I will provide Data Management Solutions with updated payment information promptly. Failure to comply may result in a service interruption.

Yes, I agree

Stale Data : *

I understand that the data provided to the Data Management Solutions team should be dated within the week uploaded. This will allow for Optimal audit results.

Yes, I agree

Data Format: *

I understand that all data should be provided to the Data Management Solutions team in on of the following supported file types; xlsx, .xls or .csv

Yes, I agree

Professional Liability Insurance

Data Management Solutions LLC shall obtain and always maintain during the prosecution of the work under this Agreement Professional Liability insurance to include Errors and Omissions and Cybersecurity.

Signature to accept Terms & Conditions*

Your Full Name

Your Title

Date & Time*

Select Date ×

Form successfully restored

STEP 1 : Request Form

Audits on Demand

Audit Section : If you do not wish to submit all audits being purchased today, DMS will send you a link to submit future audits at the time of need.

STEP 2 : Upload Data

STEP 3 : We Will Contact You

STEP 4 : Login Details

STEP 5 : Timeframe

STEP 6 : Email Confirmation

STEP 7 : Questions

Select an Audit Plan

Pricing / Billing

Service Agreement

Your form has been submitted