Common use of Claims Review Clause in Contracts

Claims Review. The IRO shall review claims submitted by Xxx and reimbursed by the Medicaid 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 B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Apria and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx VITAS and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Progenity and reimbursed by the Medicare and Medicaid programprograms, to determine whether the medical necessity of the items and services furnished were medically necessary and was appropriately documented and whether the claims were correctly coded, submitted and reimbursed (Claims Review) and shall‌ shall prepare a Claims Review Report, as outlined in Appendix B C to this CIA, which is incorporated by reference.. Progenity, Inc. Corporate Integrity Agreement

Claims Review. The IRO shall review claims submitted by Xxx Behavioral Health Facilities and reimbursed by the Medicaid programMedicare, Medicaid, and TRICARE 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Genova and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Diversicare and reimbursed by the Medicaid 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 shall prepare a the Claims Review ReportReports, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx or on behalf of Xxxxxxx USD Medical Center and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Prime and reimbursed by the Medicaid 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 shall prepare a Claims Review Report, as outlined in Appendix B C to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx PPOA and reimbursed by the Medicare and Medicaid programprograms, 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 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 review claims submitted by Xxx SERA and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx MTL and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Vibra and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Liberty and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx APM, Park Center, and Xxxxxx and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B C to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx XXX and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Guardian and reimbursed by the Medicaid 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx the Covered Facilities and reimbursed by the Medicaid 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx AAMC and reimbursed by the Medicaid programMedicare, Medicaid, and TRICARE 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Plaza and reimbursed by the Medicaid programMedicare Part A, to determine whether the items and services furnished were medically necessary and appropriately documented and whether the claims were correctly coded, submitted submitted, and reimbursed (Claims Review) and shall‌ shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Medstar and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx MTC and reimbursed by the Medicaid 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌‌

Claims Review. The IRO shall review claims submitted by Xxx AmeriCare and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Prime and reimbursed by the Medicaid 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Health Quest Covered Entities and reimbursed by the Medicare and Medicaid programprograms, to determine whether the items and services furnished were medically necessary and appropriately documented and whether the claims were correctly coded, submitted submitted, and reimbursed (Claims Review) and shall‌ shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Xxxxxxxxx and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx VCMC and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Hospicio and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review Arora’s fee-for-service claims submitted by Xxx to and reimbursed by the Medicaid Medicare program, to determine whether the items and services furnished were medically necessary and appropriately documented documented, and whether the claims were correctly coded, submitted submitted, and reimbursed (Claims Review) and shall‌ shall prepare a Claims Review Report, as outlined in Appendix B to this CIAIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Sava and reimbursed by the Medicaid Medicare program, to determine whether the items and services furnished were medically necessary and reasonable and appropriately documented and whether the claims were correctly coded, submitted and reimbursed (Claims Review) and shall‌ shall prepare a Claims Review Report, as outlined in Appendix B C to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx FCVN and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx SNAP and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Xxxxxxxx and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Agendia and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Diversicare and reimbursed xxxxxxxxxx by the Medicaid 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 shall prepare a the Claims Review ReportReports, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Radeas and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B C to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Xxxxxxxx and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Xxxx Xxxxxxx and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Oglethorpe and reimbursed by the Medicare and Medicaid programprograms, to determine whether the patient admissions and lengths of stay were medically necessary and appropriate, whether items and services furnished were medically necessary and appropriately documented and whether the claims were correctly coded, submitted and reimbursed (Claims Review) and shall‌ shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Progenity and reimbursed by the Medicare and Medicaid programprograms, to determine whether the medical necessity of the items and services furnished were medically necessary and was appropriately documented and whether the claims were correctly coded, submitted and reimbursed (Claims Review) and shall‌ shall prepare a Claims Review Report, as outlined in Appendix B C to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx PFH and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Xxxxxx and reimbursed by the Medicaid programFederal health care 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx THM and reimbursed by the Medicaid 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx XXxxxxx and reimbursed by the Medicare and state Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Xxxx and reimbursed by the Medicaid Medicare program, to determine whether the items and services furnished were medically necessary and reasonable and appropriately documented and whether the claims were correctly coded, submitted and reimbursed (Claims Review) and shall‌ shall prepare a Claims Review Report, as outlined in Appendix B C to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Xxxxx and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx UCI and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.

Claims Review. The IRO shall review claims submitted by Xxx Gamma and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌

Claims Review. The IRO shall review claims submitted by Xxx Preferred Imaging and reimbursed by the Medicare and Medicaid programprograms, 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 shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.reference.‌