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 Progenity and reimbursed by the Medicare and Medicaid programs, to determine whether the medical necessity of the items and services furnished was 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. The IRO shall conduct a review of Xxxxxx’x 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 perform the Claims Review for each of the three Reporting Periods.
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.
32.2.2.2 Where a claim dispute, and/or Committee related procedural issues, cannot be resolved by consensus of the Committee, the parties will be joined by a seventh member who shall be a mutually agreed upon independent third party. The selection of the independent third party shall be made on agreement of the parties from the GSB Roster provided for under the collective agreement.
32.2.2.3 The Committee, with signed authorization from the employee, shall be entitled to full disclosure from the Carrier(s) when claims are refused under a Benefit Plan.
32.2.2.4 Appropriate impartial medical consultants shall be available to the committee in an advisory capacity to provide information on the nature of specific illnesses or disabilities.
32.2.2.5.1 The fees and expenses of the medical consultants referred to in this Article and the independent third party referred to in this Article shall be divided equally between the Employer and the Association.
Claims Review. An IRO shall perform a review of OFX’s billing and claims submission to the Federal health care programs and the reimbursement received (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 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.
Claims Review. The IRO shall perform the Skilled Nursing Facility Claims Review (Claims Review) annually to cover each of the Reporting Periods. The Claims Review shall be conducted at at three FHS Entity facilities (each a “Subject Facility” and collectively referred to as the “Subject Facilities”), for each Reporting Period. The IRO shall perform all components of each Claims Review.
Claims Review. The IRO shall review Good Shepherd’s coding, billing, and claims submission to the Medicare and state Medicaid programs and the reimbursement received (Claims Review) and shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.
