Common use of Claims Review Clause in Contracts

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 conduct a review of LFACPractitioner’s claims submitted to and reimbursed by the Medicare Medicare, Medicaid, TRICARE and Medicaid the Department of Veterans Affairs, Veterans Health Administration 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)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.Review.‌‌

Claims Review. The IRO shall conduct a review of LFACXx. Xxxxxxxx and Fleckner, P.C.’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)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-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.Review.‌

Claims Review. The IRO shall conduct a review of LFAC’s claims submitted to and reimbursed by the Medicare and Medicaid programsprograms by or on behalf of Xx. Xxxxx and the Cancer Centers, 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)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.Review.‌

Claims Review. The IRO shall conduct a review of LFACCenter for Pain Management’s claims submitted to and reimbursed by the Medicare and Medicaid programs, to determine whether (a) the items and services furnished were medically necessary and appropriately documented (including that the records underlying the claims have not been duplicated or cloned)documented, and whether the claims were correctly coded, submitted, and reimbursed reimbursed; and (b) whether any diagnostic testing ordered was medically reasonable and necessary, 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-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 conduct a review of LFACAPS’s claims submitted to and reimbursed by the Medicare, Medicare Managed Care, Medicaid Managed Care, and state Medicaid programs, 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 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.