Claims Review. The IRO shall perform the Claims Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Claims Review.
Claims Review. The IRO shall review claims submitted by Genova and reimbursed by the Medicare and Medicaid programs, to determine whether the items and services furnished were medically necessary and appropriately documented and whether the claims were correctly coded, submitted and reimbursed (Claims Review) and shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.
Claims Review. The IRO shall conduct a review of Practitioner’s claims submitted to and reimbursed by the Medicare and Medicaid programs, to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claims were correctly coded, submitted, and reimbursed for each three-month period during the term of this IA (Quarterly Claims Review) and shall prepare a Quarterly Claims Review Report, as outlined in Appendix B to this IA, which is incorporated by reference. The first three-month period for purposes of the Quarterly Claims Review requirement shall begin 30 days after the Effective Date. Each Quarterly Claims Review Report shall be submitted to OIG within 60 days following the end of the three-month period covered by the Quarterly Claims Review.
Claims Review. Blue Shield reserves the right to review all claims to determine whether any exclusions or limitations apply.
Claims Review. The IRO shall review fee-for service claims submitted by CHN and reimbursed by the Medicare program, to determine whether the items and services furnished were medically necessary and appropriately documented and whether the claims were correctly coded, submitted, and reimbursed (Claims Review) and shall prepare a Claims Review Report, as outlined in Appendix C to this CIA, which is incorporated by reference.
Claims Review. 32.2.2.1 All complaints by individuals that they have not received their proper entitlement to benefits under the Benefit Plans shall be made to the Committee.
Claims Review. The IRO shall perform the Claims Review for each of the three Reporting Periods.
Claims Review. The IRO shall perform the Skilled Nursing Facility Claims Review (Claims Review) annually to cover each of the five Reporting Periods. The Claims Review shall be conducted at 4% of the Saber Facilities or at least 5 facilities, whichever is greater (“Subject Facilities”), for each Reporting Period. The IRO shall perform all components of each Claims Review.
Claims Review. In any case in which a claim for Plan benefits of a Participant or beneficiary is denied or modified, the Committee shall furnish written notice to the claimant within ninety days after receipt of such claim for Plan benefits (or within 180 days if additional information requested by the Committee necessitates an extension of the ninety-day period, and the claimant is informed of such extension in writing within the original ninety-day period), which notice shall:
Claims Review. The IRO shall conduct a review of LFAC’s claims submitted to and reimbursed by the Medicare and Medicaid programs, to determine whether the items and services furnished were medically necessary and appropriately documented (including that the records underlying the claims have not been duplicated or cloned), and whether the claims were correctly coded, submitted, and reimbursed for each three-month period during the term of this IA (Quarterly Claims Review) and shall prepare a Quarterly Claims Review Report, as outlined in Appendix B to this IA, which is incorporated by reference. The first three-month period for purposes of the Quarterly Claims Review requirement shall begin 30 days after the Effective Date. Each Quarterly Claims Review Report shall be submitted to OIG within 60 days following the end of the three-month period covered by the Quarterly Claims Review.