Claims Records Sample Clauses

Claims Records. Pharmacy BenefitDirect shall maintain, in the original form, or on electronic media, Claims received from Pharmacies and adequate records to verify payment to Pharmacies, and shall make information obtained from said claims and other records available to Client upon request. Exhibit X-x (By Reference) Pharmacy BenefitDirect Management Reports CLAIMS ITEMIZATION REPORT (biweekly) – prescription claims activity for each member during each two-week billing period. UNAUTHORIZED UTILIZATION REPORT (biweekly) – rejected claims and reason for rejection for each two-week billing period. CLAIMS SUMMARY REPORT (monthly) – cardholder claims activity for the current report period providing breakdown by cardholder, spouse, dependents and total. PROVIDER UTILIZATION REPORT (quarterly) – drug utilization and related cost data for the previous three-month cycle sorted by therapeutic class. CLAIMS COST ANALYSIS (monthly) – the single most important report in the system providing detailed cost and utilization data to assist in fiscal management. It provides monthly comparisons of relational data and rolling averages for a six-month time period. REJECTED CLAIMS REPORT (monthly) – rejected claims activity — reasons for, how many and how much – for the current report period. INCURRED CLAIMS REPORT (monthly) – monthly record of history and current claims activity that, by extrapolation of data, can provide for projection of incurred liabilities. GENERIC UTILIZATION REPORT (monthly) – a cumulative record, by month and year, of generic utilization showing extent of generic substitution, cost savings, and unrealized potential. PHYSICIAN UTILIZATION REPORT (monthly) – physician activity for the current report period detailing number of prescriptions, total cost, average prescription cost, and generic prescribing data. MANUFACTURER REBATE REPORT (quarterly, on demand) – summary of drug purchases for the previous quarter, by therapeutic class and manufacturer, to be used in claiming manufacturer rebates. CARDHOLDER UTILIZATION REVIEW (monthly, on demand) – part of a three-part series to aid in identifying potential cardholder abuse. This report details circumstances of purchases that tend to be indicative of abuse – multiple pharmacies, multiple physicians, excessive use of drugs of abuse, etc. CARDHOLDER UTILIZATION SUMMARY (monthly, on demand) – the second report in the cardholder abuse series. Through the use of weighted point scales, this report analyzes the information from the ...
Sample 1
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Claims Records. When this Agreement terminates, Plan Supervisor shall provide to Plan or its designee a historical accounting of claims payments. At the option of Plan Supervisor, all records of the Plan shall be returned to the Employer upon termination of this Agreement. Employer shall reimburse the Plan Supervisor for the cost of retrieving Plan records from storage, if applicable, and shipping Plan records to the Employer. The delivery of records maintained on hard copy files, microfilm or magnetic tape, at Plan Supervisor’s option, shall be deemed to be in compliance with this Section. In the event records are stored on microfilm and a retrieval fee is charged to Plan Supervisor, Employer shall pay such fee. In the event records are stored on magnetic tape, an explanation of record format shall be provided. At the time the transfer of records occurs, Plan Supervisor shall be relieved of further responsibility for performing any of the services enumerated in this Agreement.
Sample 1
Claims Records. When this Agreement terminates, PNC shall provide to Plan or its designee a historical accounting of Benefits. At the option of PNC, all records of the Plan shall be returned to the Employer upon termination of this Agreement. Employer shall reimburse the PNC for the cost of retrieving Plan records from storage, if applicable, and shipping Plan records to the Employer. The delivery of records maintained on hard copy files, microfilm or magnetic tape, at PNC's option, shall be deemed to be in compliance with this Section. In the event records are stored on microfilm and a retrieval fee is charged to PNC, Employer shall pay such fee. In the event records are stored on magnetic tape, an explanation of record format shall be provided. At the time the transfer of records occurs, PNC shall be relieved of further responsibility for performing any of the services enumerated in this Agreement.
Sample 1

Related to Claims Records

  • Contractor’s Records The Contractor shall keep true and accurate accounts, records, books and data which shall correctly reflect the business transacted by the Contractor in accordance with generally accepted accounting principles. These records shall be stored in Orange County for a period of three (3) years after final payment is received from the County. Storage of records in another county will require written approval from the County of Orange assigned Deputy Purchasing Agent.

  • Time Records The employer will keep a record for a continuous period of seven (7) years from which can be readily ascertained the following:

  • Client Records 26.2.1 CONTRACTOR shall prepare and maintain accurate and complete records of clients served and dates and type of services provided under the terms of this Contract in a form acceptable to ADMINISTRATOR. 26.2.2 CONTRACTOR shall keep all COUNTY data provided to CONTRACTOR during the term(s) of this Contract for a minimum of five

  • Account Records Upon request of the Master Servicer, the Servicer shall also cause the depository for each of the accounts described in Section 18.2.1 hereof to forward directly to the Master Servicer, copies of all monthly account statements for the preceding monthly reporting period.

  • Documents, Records and Funds in Possession of the Servicer to be Held for the Trustee......................... Section 3.17

  • Audits and Records 7.5.1 The Contractor agrees that the representatives of the Office of the City Auditor or other authorized representatives of the City shall have access to, and the right to audit, examine, or reproduce, any and all records of the Contractor related to the performance under this Contract. The Contractor shall retain all such records for a period of three (3) years after final payment on this Contract or until all audit and litigation matters that the City has brought to the attention of the Contractor are resolved, whichever is longer. The Contractor agrees to refund to the City any overpayments disclosed by any such audit.

  • Business Records Keep adequate records and books of account with respect to Borrower’s business activities in which proper entries are made in accordance with sound bookkeeping practices reflecting all financial transactions of Borrower.

  • Project Records Borrower shall: Make and keep books, records, and accounts, in such reasonable detail, so as to fully, accurately, and fairly reflect the activities of Borrower. Record the Project’s assets, liabilities, revenues, expenses, receipts and disbursements in separate accounts from any other assets, liabilities, revenues, expenses, receipts and disbursements of Borrower so as to permit the production of a Statement of Financial Position, a Statement of Profit and Loss (Statement of Activities), and a Statement of Cash Flows for Borrower in which the activities of Borrower are separately identifiable from the activities of the Operator, unless Borrower is also Operator. Devise and maintain a system of internal accounting controls sufficient to provide reasonable assurances that: Transactions are executed, and access to assets is permitted, only in accordance with Xxxxxxxx’s authorization; Transactions are accurately and timely recorded to permit the preparation of quarterly and annual financial reports in conformity with applicable Program Obligations; Transactions are timely recorded in sufficient detail so as to permit an efficient audit of the Borrower’s books and records in accordance with Generally Accepted Auditing Standards (GAAS), Generally Accepted Government Auditing Standards (GAGAS), and other applicable Program Obligations; and Transactions are timely recorded in sufficient detail so as to maintain accountability of the Borrower’s assets. The recorded accountability for assets shall be compared with the existing assets at reasonable intervals, but not less than annually, and appropriate action shall be taken with respect to any differences. Make the books, records and accounts of Borrower available for inspection by HUD or its authorized representatives, after reasonable prior notice, during normal business hours, at the Project or other mutually agreeable location or, at HUD’s request, shall provide legible copies of such documents to HUD or its authorized representatives within a reasonable time after HUD or its authorized representative makes a request for such documents. Include as a requirement in any operating or management contract that the books, records, and accounts of any agent of Borrower, as they pertain to the operations of the Project, shall be kept in accordance with the requirements of this Section 19 and be available for examination by HUD or its authorized representatives after reasonable prior notice during customary business hours at the Project or other mutually agreeable location or, at HUD’s request, the Management Agent shall provide legible copies of such documents to HUD or its authorized representatives within a reasonable time after HUD or its authorized representative makes the request.

  • Student Records The School shall maintain student records for current and former students in accordance with the requirements of State and federal law, including the Family Education Rights and Privacy Act, 20 U.S.C. § 1232g, as may be amended from time to time.

  • Patient Records Upon termination of this Agreement, the New PC shall retain all patient dental records maintained by the New PC or the MSO in the name of the New PC. During the term of this Agreement, and thereafter, the New PC or its designee shall have reasonable access during normal business hours to the New PC's and the MSO's records, including, but not limited to, records of collections, expenses and disbursements as kept by the MSO in performing the MSO's obligations under this Agreement, and the New PC may copy any or all such records.

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