Common use of Claims Review Findings Clause in Contracts

Claims Review Findings. a. Narrative Results.‌‌ i. A description of CFS’s billing and coding system(s), including the identification, by position description, of the personnel involved in coding and billing. ii. A description of controls in place at CFS to ensure that all items and services furnished by CFS are correctly coded, appropriately documented, and medically necessary. iii. A narrative explanation of the results of the IRO’s review of the Claims Review Sample, including an explanation of all errors identified by the IRO. b. Quantitative Results.‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by CFS differed from what should have been the correct coding. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary. iv. Total dollar amount of Paid Claims included in the Claims Review Sample and the net Overpayment associated with the Claims Review Sample.‌ v. Error Rate in the Claims Review Sample.‌

Claims Review Findings. a. Narrative Results.‌‌ i. A description of CFS’s Xx. Xxxxx’x billing and coding system(s), including the identification, by position description, of the personnel involved in coding and billing. ii. A description of controls in place at CFS Xx. Xxxxx to ensure that all items and services furnished by CFS Xx. Xxxxx are correctly coded, appropriately documented, and medically necessary. iii. A narrative explanation of the results of the IRO’s review of the Claims Review Sample, including an explanation of all errors identified by the IRO. b. Quantitative Results.‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by CFS Xx. Xxxxx differed from what should have been the correct coding. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary. iv. Total dollar amount of Paid Claims included in the Claims Review Sample and the net Overpayment associated with the Claims Review Sample.‌ v. Error Rate in the Claims Review Sample.‌

Claims Review Findings. a. Narrative Results.‌‌ i. A description of CFSSilver Lake’s billing and coding system(s), including the identification, by position description, of the personnel involved in coding and billing. ii. A description of controls in place at CFS Silver Lake to ensure that all items and services furnished by CFS Silver Lake are correctly coded, appropriately documented, and medically necessary. iii. A narrative explanation of the results of the IRO’s review of the Claims Review Sample, including an explanation of all errors identified by the IRO. b. Quantitative Results.‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by CFS Silver Lake differed from what should have been the correct coding. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary. iv. Total dollar amount of Paid Claims included in the Claims Review Sample and the net Overpayment associated with the Claims Review Sample.‌ v. Error Rate in the Claims Review Sample.‌

Claims Review Findings. a. Narrative Results.‌‌ i. A description of CFSTauth’s billing and coding system(s), including the identification, by position description, of the personnel involved in coding and billing. ii. A description of controls in place at CFS Tauth to ensure that all items and services furnished by CFS Tauth are correctly coded, appropriately documented, and medically necessary. iii. A narrative explanation of the results of the IRO’s review of the Claims Review Sample, including an explanation of all errors identified by the IRO. b. Quantitative Results.‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by CFS Tauth differed from what should have been the correct coding. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary. iv. Total dollar amount of Paid Claims included in the Claims Review Sample and the net Overpayment associated with the Claims Review Sample.‌Sample.‌‌‌ v. Error Rate in the Claims Review Sample.‌

Claims Review Findings. a. Narrative Results.‌‌ i. A description of CFSNumotion’s billing and coding system(s), including the identification, by position description, of the personnel involved in coding and billing. ii. A description of controls in place at CFS Numotion to ensure that all items and services furnished by CFS Numotion are correctly coded, appropriately documented, and medically necessary. iii. A narrative explanation of the results of the IRO’s review of the Claims Review Sample, including an explanation of all errors identified by the IRO. b. Quantitative Results.‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by CFS Numotion differed from what should have been the correct coding. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary. iv. Total dollar amount of Paid Claims included in the Claims Review Sample and the net Overpayment associated with the Claims Review Sample.‌ v. Error Rate in the Claims Review Sample.‌

Claims Review Findings. a. Narrative Results.‌‌ i. A description of CFSDOCS’s billing and coding system(s), including the identification, by position description, of the personnel involved in coding and billing. ii. A description of controls in place at CFS DOCS to ensure that all items and services furnished by CFS DOCS are correctly coded, appropriately documented, and medically necessary. iii. A narrative explanation of the results of the IRO’s review of the Claims Review Sample, including an explanation of all errors identified by the IRO.IRO.‌ b. Quantitative Results.‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by CFS DOCS differed from what should have been the correct coding. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary. iv. Total dollar amount of Paid Claims included in the Claims Review Sample and the net Overpayment associated with the Claims Review Sample.‌ v. Error Rate in the Claims Review Sample.‌