BILL REVIEW Sample Clauses

BILL REVIEW. In order to assure the most accurate billing and thus alleviate any delays in payment which may result in your organization incurring unnecessary finance charges, the Group will be expected to: Request and Review its bill on a daily basis Request, review and sign all Banquet Event Orders prior to the event. Request, review and sign all event Banquet checks at the conclusion of the event. Request and review final bill prior to check-out.
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BILL REVIEW. Provider agrees to cooperate with any requests by IHN CCO, or its agent, to review any bills submitted by Provider to determine whether a bill submitted for services rendered to a Member is a Covered Service under the Member’s Health Benefit Plan, subject to this Agreement, properly billed to the services provided (as reflected in the medical record), and that payments made to the Provider were accurate, in accordance with the terms and conditions set forth herein.
BILL REVIEW a. The MCO shall load all County bill review and payment history data available from the prior MCO for the last ten (10) years, regardless of the amount of data at no charge to the County or its TPA. b. The MCO shall perform the programming requirements, at no charge to the County or TPA, for the interface between the MCO and the TPA’s claims management system. Data interfacing and other system tests shall be completed successfully no less than thirty (30) days prior to program “Go Live” date at no charge to the County. Except as provided in Attachment B, II, A. c. The MCO shall integrate utilization review determinations into bill review software, at no additional charge, so that bills are accepted for review and payments recommended for authorized or “Certified” medical treatment only. d. The MCO shall review and process 90% of all properly coded medical bills within five (5) business days of receipt of the bill and agree to comply with all California Workers’ Compensation bill review statutes and regulations. The MCO shall reimburse the County for penalties incurred resulting from the MCO’s negligence or willful action or inaction to comply with all California Workers’ Compensation bill review statutes and regulations. e. The MCO shall accurately reduce medical provider charges to the California Official Medical Fee Schedule (OMFS). OMFS savings shall be categorized separately from all other types of savings recorded in the bill review software. f. The MCO shall apply all pre-negotiated medical reimbursement rates under PPO, MPN and Specialty Network provider contracts, as well as with direct medical organizations, physicians, or facilities under “Client Contracted Rates” or “Single Case Agreements”. Additionally, the MCO shall apply other review methods such as nurse desk audits, specialty reviews and Direct Negotiations when applicable. g. The MCO shall manually review all complex surgical bills for unbundling and upcoding, and with adjuster approval shall enter medical bill negotiations with providers. h. The MCO shall review in-network and out-of-network bills related to catastrophic claims and/or Complex injuries as determined by the County (i.e. traumatic brain, major burn, spinal cord, multiple trauma, and post-acute injuries). The MCO shall obtain the highest reductions possible through Direct Negotiations with the provider utilizing a senior-level bill review expert, evidenced-based guidelines, and benchmarked data of like and kind rates for si...

Related to BILL REVIEW

  • Log Reviews All systems processing and/or storing PHI COUNTY discloses to 11 CONTRACTOR or CONTRACTOR creates, receives, maintains, or transmits on behalf of COUNTY 12 must have a routine procedure in place to review system logs for unauthorized access.

  • Annual Reviews Within thirty (30) days after each annual anniversary of the Effective Date of this Agreement, the Company shall review Employee’s performance of his duties pursuant to this Agreement and advise Employee of the results of that review; provided, however, that Company may elect to conduct a partial-year performance review in order to synchronize Employee’s annual review date with that of the Company’s other executives. In connection with each such review, the Company shall evaluate whether any increase in Employee’s compensation under Section 2, below, is appropriate.

  • Periodic Reviews During January of each year during the term hereof, the Board of Directors of the Company shall review Executive's Annual Salary, bonus, stock options, and additional benefits then being provided to Executive. Following each such review, the Company may in its discretion increase the Annual Salary, bonus, stock options, and benefits; however, the Company shall not decrease such items during the period Executive serves as an employee of the Company. Prior to November 30th of each year during the term hereof, the Board of Directors of the Company shall communicate in writing the results of such review to Executive.

  • Annual Review The Board of Directors during the Contract Period shall review annually, or at more frequent intervals which the Board of Directors determines is appropriate, the Executive’s compensation and shall award the Executive additional compensation to reflect the Executive’s performance, the performance of the Company and competitive compensation levels, all as determined in the discretion of the Board of Directors.

  • Design Review ‌ (a) Where so specified in Schedule A (Scope of Goods and Services) or as otherwise instructed by the City, the Supplier shall submit design-related Documentation for review by the City, and shall not proceed with work on the basis of such design Documentation until the City’s approval of such Documentation has been received in writing. (b) None of: (i) the submission of Documentation to the City by the Supplier; (ii) its examination by or on behalf of the City; or (iii) the making of any comment thereon (including any approval thereof) shall in any way relieve the Supplier of any of its obligations under this Agreement or of its duty to take reasonable steps to ensure the accuracy and correctness of such Documentation, and its suitability to the matter to which it relates.

  • Periodic Review The General Counsel shall periodically review the Procurement Integrity Procedures with OSC personnel in order to ascertain potential areas of exposure to improper influence and to adopt desirable revisions for more effective avoidance of improper influences.

  • Program Review The State ECEAP Office will conduct a review of each contractor’s compliance with the ECEAP Contract and ECEAP Performance Standards every four years. The review will involve ECEAP staff and parents. After the Program Review, the State ECEAP Office will provide the contractor with a Program Review report. The contractor must submit an ECEAP Corrective Action Plan for non-compliance with ECEAP Performance Standards. The Plan must be approved by the State ECEAP Office.

  • Classification Review Grand Valley State University and APSS shall jointly determine the review assessment survey instrument to be used at Grand Valley State University. The parties shall maintain a Joint Review Committee, composed of three members appointed by the Human Resources Office and three members appointed by the Alliance. Bargaining unit members questioning the assigned classification of their position may do so by using the following procedure: A. Meet with the Employment Manager in the Human Resources Office to discuss the review process, changes in their job responsibilities, duties and any other process questions they may have. B. PSS member will fill out the assessment survey and email to the Employment Manager along with any other documentation that supports the request. The survey instrument will be jointly administered/reviewed by the Assessment Team (consisting of the Employment Manager and an Alliance member of the Joint Review Committee). A meeting with the PSS is scheduled for a verbal review of the documentation and to answer any questions the Assessment Team may have. The supervisor or appointing officer is encouraged to attend. If the Assessment Team believes a job site visit is warranted as a result of the survey information, they will schedule a time for a joint visit. C. The completed survey instrument shall be coded. The survey results, as determined by the Assessment Team, shall be shared with the survey participant. D. After receiving the survey results, the survey participant, if they so choose shall have the opportunity to meet with the Joint Review Committee for additional input and appeal. Any additional information shall be reviewed by the Committee, and where the Committee feels it is necessary, the survey will be recoded, in a manner mutually agreeable. E. The Joint Review Committee shall then deliberate as to the merit of the upgrade requested by the participant. If the Committee is not able to reach a consensus, the University will decide on the classification. The Alliance may appeal that decision through the arbitration procedure of the collective bargaining agreement. Professional Support Staff members may engage in the review process no more than once per year. Supervisors questioning the assigned classification of a staff member’s position shall provide supporting rationale, complete an assessment survey instrument and discuss with Manager of Employment. The Manager of Employment shall notify an Alliance Representative that a Supervisor is reviewing a staff member’s classification. The review and outcome shall be completed within 45 working days unless the Alliance Representative and Manager of Employment mutually agreed to an extension. The Alliance will be provided with the scored instrument and any supporting rationale.

  • Reviews (a) During the term of this Agreement and for 7 years after the term of this Agreement, the HSP agrees that the Funder or its authorized representatives may conduct a Review of the HSP to confirm the HSP’s fulfillment of its obligations under this Agreement. For these purposes the Funder or its authorized representatives may, upon 24 hours’ Notice to the HSP and during normal business hours enter the HSP’s premises to: inspect and copy any financial records, invoices and other finance- related documents, other than personal health information as defined in the Enabling Legislation, in the possession or under the control of the HSP which relate to the Funding or otherwise to the Services; and inspect and copy non-financial records, other than personal health information as defined in the Enabling Legislation, in the possession or under the control of the HSP which relate to the Funding, the Services or otherwise to the performance of the HSP under this Agreement. (b) The cost of any Review will be borne by the HSP if the Review: (1) was made necessary because the HSP did not comply with a requirement under the Enabling Legislation or this Agreement; or (2) indicates that the HSP has not fulfilled its obligations under this Agreement, including its obligations under Applicable Law and Applicable Policy. (c) To assist in respect of the rights set out in (a) above, the HSP shall disclose any information requested by the Funder or its authorized representatives and shall do so in a form requested by the Funder or its authorized representatives. (d) The HSP may not commence a proceeding for damages or otherwise against any person with respect to any act done or omitted to be done, any conclusion reached or report submitted that is done in good faith in respect of a Review.

  • Peer Review Dental Group, after consultation with the Joint ----------- Operations Committee, shall implement, regularly review, modify as necessary or appropriate and obtain the commitment of Providers to actively participate in peer review procedures for Providers. Dental Group shall assist Manager in the production of periodic reports describing the results of such procedures. Dental Group shall provide Manager with prompt notice of any information that raises a reasonable risk to the health and safety of Group Patients or Beneficiaries. In any event, after consultation with the Joint Operations Committee, Dental Group shall take such action as may be reasonably warranted under the facts and circumstances.

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