Claims Data. To the knowledge of Aspen Parent, the historical claims data made available to the Reinsurer by Aspen Parent and its subsidiaries as regards the Reinsured Policies is accurate in all material respects as of the date indicated. The reserves and other provisions made for claims, benefits and any other liabilities with respect to the Reinsured Policies, whether reported or incurred but not reported, as established or reflected on Aspen’s most recent statutory annual statement and statutory quarterly statement were calculated in all material respects in accordance with (i) statutory accounting principles and generally accepted actuarial principles, in each case consistently applied, (ii) Applicable Law and (iii) otherwise in accordance with the terms of the Reinsured Policies. Aspen Parent has made available to the Reinsurer all information material to the liabilities reinsured hereunder. For the avoidance of doubt, no representation or warranty is made as to the adequacy or sufficiency of reserves as of any date. For the avoidance of doubt, only Aspen Parent is making the representations and warranties set forth in this Section 11.1(g), and no reinsured that comprises the definition of “Aspen” is making, or shall be deemed to be making, the representations and warranties set forth in this Section 11.1(g).
Claims Data. This data will include:
(i) Three years of historical Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview from the 36 months immediately preceding the effective date of the Beneficiary’s alignment to the ACO;
(ii) Monthly Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview for REACH Beneficiaries;
(iii) Monthly Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for claims with a date of service prior to the date the Beneficiary was removed from alignment to the ACO; and
(iv) Weekly claims data files specified in the Reporting and Data Sharing Overview regarding those claims subject to the TCC Fee Reduction (if the ACO has selected TCC Payment as its Capitation Payment Mechanism) or the PCC Fee Reduction (if the ACO has selected PCC Payment as its Capitation Payment Mechanism) and, if the ACO has selected to participate in the APO, the APO Fee Reduction.
Claims Data. This system must be capable of collecting, storing and producing information for the purposes of financial, medical and operational management.
Claims Data. Participating Employer shall: Cooperate with RAND in its performance of the Research and instruct its third-party claims administrator to provide RAND with access to the information and documents described in Exhibit B (“Claims Data Including Protected Health Information”); Take all steps necessary, including obtaining any required licenses or consents, to prevent any delays in RAND's provision of the Research Report.
Claims Data. The historical claims data made available to Enstar by Maiden, Maiden Insurance or their Affiliates as regards the Subject Business is accurate in all material respects as of the date indicated; provided, however, that no representation or warranty is made as to the adequacy or sufficiency of any reserves data as of any date.
Claims Data. This data will include:
(i) Three years of historical Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview from the 36 months immediately preceding the effective date of the Beneficiary’s alignment to the ACO;
(ii) Monthly Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview for REACH Beneficiaries;
(iii) Monthly Parts A, B, and D claims data files specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for claims with a date of service prior to the date the Beneficiary was removed from alignment to the ACO;
(iv) Weekly claims data files specified in the Reporting and Data Sharing Overview regarding those claims subject to the TCC Fee Reduction (if the ACO has selected TCC Payment as its Capitation Payment Mechanism) or the PCC Fee Reduction (if the ACO has selected PCC Payment as its Capitation Payment Mechanism) and, if the ACO has selected to participate in the APO, the APO Fee Reduction;
(v) For Performance Year 2024 and each subsequent Performance Year, monthly Bundled Payments for Care Improvement (BPCI) Clinical Episode data files specified in the Reporting and Data Sharing Overview for REACH Beneficiaries; and
(vi) For Performance Year 2024 and each subsequent Performance Year, monthly Bundled Payments for Care Improvement (BPCI) Clinical Episode data files specified in the Reporting and Data Sharing Overview for Originally Aligned Beneficiaries for claims with a date of service prior to the date the Beneficiary was removed from alignment to the ACO; and
(vii) For Performance Year 2024 and each subsequent Performance Year, on at least an annual basis, as specified in the Reporting and Data Sharing Overview, data that contain hospital-specific prospective target prices for each clinical episode category.
Claims Data. (a) The submission of all Encounter Data for services rendered to Contractor’s Members during the contract period;
(b) Certification that Contractor attests that the submitted encounter claims are complete, truthful and accurate to the best knowledge and belief of Contractor’s authorized representative, subject to False Claims Act liability;
(c) Adjustments to encounter claims in the event Contractor receives payment from a Member’s Third Party Liability or Third Party recovery; and
(d) Adjustments to encounter claims in the event Contractor recovers any Provider Overpayment from a Provider.
Claims Data. Assumption: Aggregation of table data into claims records will be needed. Professional and pharmacy claims records 400 Pharmacy adjudicated claims are received weekly from VT Pharmacy Benefit Management (PBM) system and are paid in MMIS in the weekly financial cycle; receiving these from MMIS helps ensure linkage of PBM claims to financial reporting. Institutional & institutional crossover (Medicare) claims records 400 Dental claims records 150
Claims Data. BlueCross maintains Members’ claims data in its data warehouse. This claims data is available to the Employer during the term of this Agreement. Upon termination of this Agreement, this claims data will no longer be available to the Employer from the data warehouse, but it will continue to be maintained by BlueCross. Pursuant to the HIPAA privacy standards, it is infeasible for BlueCross to return or destroy the Member’s claims data received from the group health plan due to, but not limited to: ● underwriting; ● research; ● state and federal law retention requirements; ● governmental audits; ● potential litigation; and ● system restraints for segregating data. BlueCross will protect the data and limit further uses or disclosures as required by HIPAA.
Claims Data. Data elements associated with the paid health care claims of Virginia residents that will be collected by VHI for the APCD, which may include eligibility data, medical claims data, pharmacy claims data, provider data, Actual Reimbursement Amount(s), member payment responsibility, and such other data elements as are described in Code Section 32.1-276.7:1(C)(2).2
