Common use of Claims Review Sample Clause in Contracts

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on Provider’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 2 contracts

Samples: Corporate Integrity Agreement, Integrity Agreement

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Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderArora’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Medicare Paid Claims and a random sample of 100 Medicaid Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on Providerdocumentation under TEN’s documentation control and the applicable Medicare and Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Corporate Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Medicare Paid Claims and a random sample of 100 Medicaid Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderPractitioner’s documentation and the applicable Medicare and Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.reimbursed.‌‌

Appears in 1 contract

Samples: Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderTauth’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderSaini’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderRAPHA’s documentation and the applicable Medicare Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Integrity Agreement

Claims Review Sample. The IRO shall randomly select and review a random sample of 100 50 Paid Claims (Claims Review Sample)) at each Selected Facility. The IRO shall review the Paid Claims based on Provider’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Corporate Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderSilver Lake’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Corporate Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderCFS’s documentation and the applicable Medicare Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Integrity Agreement

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Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on Provider’s Xx. Xxxxx’x documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderBalotin’s documentation and the or any Owned or Controlled Entity’s documentation, applicable Medicare program requirements, and applicable State Board of Pharmacy requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.(i) each prescription

Appears in 1 contract

Samples: Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderEdgewater’s documentation and the applicable Medicare or Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Corporate Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderXxxxxx’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Integrity Agreement

Claims Review Sample. The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample). The IRO shall review the Paid Claims based on ProviderCCH’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.

Appears in 1 contract

Samples: Corporate Integrity Agreement

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