Claims Data. This data will include:
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. 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. 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. 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. This system must be capable of collecting, storing and producing information for the purposes of financial, medical and operational management. The Contractor shall develop and maintain a HIPAA compliant claims processing and payment system capable of processing, cost avoiding and paying claims in accordance with A.R.S. §36-2903 and 2904 and AHCCCS rules R9-22 Article 7. The system must be adaptable to updates in order to support future AHCCCS claims related policy requirements on a timely basis as needed. On a recurring basis (no less than quarterly based on adjudication date), AHCCCS shall provide the Contractor an electronic file of claims and encounter data for members enrolled with the Contractor who have received services, during the member’s enrollment period, from another contractor or through AHCCCS FFS for purposes of member care coordination. Data sharing will comply with Federal privacy regulations. In addition, the Contractor shall implement and meet the following milestones in order to make claims processing and payment more efficient and timely:
Claims Data a. The following Claims Data will be provided for the Drug Product, for each <insert reporting period>:
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
Claims Data. Reporting Entities shall report information for all Members, as follows: “Member” means individuals, employees, and dependents for which the Reporting Entity has an obligation to adjudicate, pay or disburse claims payments. The term includes covered lives. For employer-‐sponsored coverage, Members include certificate holders and their dependents. This definition includes members of the State Group Health Insurance Program regardless of state of residence.” Claims Data shall contain the following types of information:
Claims Data. Owner Pledgor and the Borrower hereby agree to, and shall use commercially reasonable efforts to cause Assignee to, exercise and enforce its rights under the HC Agreements to cause the Assignor or its Affiliates to continue to make available the Claims Data to Assignee, and attorneys and law firms engaged in prosecuting or otherwise pursuing recoveries through the conclusion of all recovery efforts, in each case, pursuant to the terms of the CRSA and any formal or informal processes or pattern or practice Owner Pledgor and its Affiliates have established to maximize the information flow in respect of the HC Claims, including the accessing of the patient and other claims data in respect of the HC Claims directly from the United States’ Department of Health and Human Services Centers for Medicare & Medicaid Services Medicare Data Communications Network (MDCN) portal and other similar or analogous portals and platforms and any other data collection processes that MSP has utilized or may utilize in the future to prosecute HC Claims and maximize recoveries thereunder. In furtherance and not by way of limitation of the foregoing, Owner Pledgor and its Affiliates agrees to and acknowledges Borrower’s rights to exercise or enforce any of the remedies pursuant to agreements between Affiliates of Assignee and Owner Pledgor and its Affiliates in respect of the HC Claims. To help avoid or resolve any dispute or disagreement concerning the availability of Claims Data in respect of the HC Claims, #200345476_v12 Owner Pledgor hereby agrees to, and shall use commercially reasonable efforts to cause Assignee to, exercise and enforce their respective rights under the HC Agreements to pursue by formal action or informal arrangements to cause Assignor to make available to Assignee, and attorneys and law firms engaged in prosecuting or otherwise pursuing recoveries from or under the HC Claims any underlying claims files or other data relating to such Claims Data, for any HC Claims, including in the event of the expiration or termination of the HC Agreements, and/or any agreement in furtherance of such arrangements, in order to allow such attorneys or law firms to use such Claims Data and related data to pursue recovery of the HC Claims.
