Common use of Audits and Recovery Clause in Contracts

Audits and Recovery. Provider agrees that BCBSM may conduct onsite inspections, and may photocopy, review and audit Provider's records to determine, but not necessarily limited to, verification of services provided, frequency of services provided, adherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure codes reported to BCBSM, and to obtain recoveries based on such audits as set forth in Addendum H.

Appears in 2 contracts

Samples: Provider Participation Agreement, Provider Participation Agreement

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Audits and Recovery. Provider agrees that BCBSM may conduct onsite inspections, and may photocopy, review and audit Provider's records to determine, but not necessarily limited to, verification of services provided, frequency of services provided, verification of dates services and/or appliances were provided, ordered and dispensed, adherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure codes reported to BCBSM, and to obtain recoveries based on such audits as set forth in Addendum H.

Appears in 1 contract

Samples: Provider Participation Agreement

Audits and Recovery. Provider agrees that BCBSM may conduct onsite inspections, and may photocopy, review and audit Provider's records to determine, but not necessarily limited to, verification of services provided, frequency of services provided, verification of dates services and/or appliances were provided, ordered and dispensed, adherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure codes reported to BCBSM, and to obtain recoveries based on such audits as set forth in Addendum H.G.

Appears in 1 contract

Samples: Provider Participation Agreement

Audits and Recovery. Provider agrees that BCBSM may conduct onsite inspections, and BCN may photocopy, review and audit Provider's records to determine, but not necessarily limited to, verification of services provided, frequency of services provided, adherence to BCBSM’s and BCN’s published policies, Medical Necessity of services provided, and the appropriateness of procedure codes reported to BCBSMBCBSM and BCN, and to obtain recoveries based on such audits as set forth in Addendum H.G.

Appears in 1 contract

Samples: Ambulance Provider Participation Agreement

Audits and Recovery. Provider agrees that BCBSM may conduct onsite inspections, and may photocopy, review and audit Provider's records to determine, but not necessarily limited to, verification of services provided, frequency verification of services providedPhysician prescriptions, adherence to BCBSM’s published policiespolicies (e.g. rent/purchase), verification of dates supplies/equipment/devices were ordered and delivered, Medical Necessity of services provided, and the appropriateness of procedure codes reported to BCBSM, and to obtain recoveries based on such audits as set forth in Addendum H.

Appears in 1 contract

Samples: Durable Medical Equipment/Prosthetic and Orthotic Supplier Provider Participation Agreement

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Audits and Recovery. Provider agrees that BCBSM may conduct onsite inspections, and may photocopy, review and audit Provider's records to determine, but not necessarily limited to, verification of services provided, frequency of services provided, adherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure codes reported to BCBSM, and to obtain recoveries based on such audits as set forth in Addendum H.

Appears in 1 contract

Samples: Provider Participation Agreement

Audits and Recovery. Provider agrees that BCBSM may conduct onsite inspections, and may photocopy, review and audit Provider's records to determine, but not necessarily limited to, verification of services provided, frequency of services provided, adherence to BCBSM’s published policies, Medical Necessity of services provided, and the appropriateness of procedure codes reported to BCBSM, BCBSM and to obtain recoveries based on such audits as set forth in Addendum H.F.

Appears in 1 contract

Samples: Provider Participation Agreement

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