Eligibility Review. Any claimant deemed ineligible by the Claims Evaluator may appeal that decision to the Special Master or her designee by filing an eligibility appeal within 30 days on forms created by the office of the Special Master.
Eligibility Review. Borrowers re- ceiving interest assistance will be re- viewed annually within 30 to 60 days prior to the anniversary date of the loan. All existing agreements must be reviewed and processed for the upcom- ing 12 months during the review period. Interest assistance will not be renewed if the amount that the borrower quali- fies for is less than $20 per month.
Eligibility Review. One (1) additional reader for a total pool of three (3) readers, sharing the workload, for the eligibility review. • Screening timepoints will be re-read by a second reader for screening timepoints with a score of < 2, assuming 10% of timepoints will be re-read. Primary Review:
Eligibility Review. The IRO shall perform the Eligibility Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Eligibility Review.
Eligibility Review. The IRO shall select a Beneficiary Sample. For each Medicare beneficiary in the Beneficiary Sample, the IRO shall randomly select a Claim Period to be reviewed (Selected Claim Period). The IRO shall review the medical records of each Medicare beneficiary in the Beneficiary Sample based on the supporting documentation available at VITAS's offices or under VITAS's control and applicable billing and coding regulations and guidance to determine whether the beneficiary was eligible for hospice services for the Selected Claim Period. For any beneficiary in the Beneficiary Sample that results in a determination by the IRO that the beneficiary was not eligible for the hospice benefit during the Selected Claim Period, the IRO shall review all claims for hospice services billed by VITAS for that beneficiary to determine whether the beneficiary was eligible for hospice services. The IRO shall submit a supplemental report no later than 90 days after the IRO completes its report. VITAS shall refund any Overpayments identified as a result of this additional review and documentation of the refund of any identified Overpayments shall be made available to OIG upon request. Additionally, the IRO shall perform a review of the system(s) and process(es) that resulted in VITAS's erroneous determination that the beneficiary was eligible for the hospice benefit, to identify any problems or weaknesses that may have resulted in the identified error(s). The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) for determining eligibility for the hospice benefit.
Eligibility Review. The IRO shall conduct the “Eligibility Review” to determine whether Medicare beneficiaries meet hospice eligibility criteria and shall include a review of (1) initial admissions (Admission Review) and (2) the most recent recertification period for Long Length of Stay patients (Long Length of Stay Review). The applicable definitions, procedures, and reporting requirements are outlined in Appendix B to this CIA, which is incorporated by reference.
Eligibility Review. The IRO shall select a Beneficiary Sample. The IRO shall review the medical records of the Medicare and Medicaid beneficiaries in the Beneficiary Sample to determine whether the beneficiaries were eligible for hospice services for each Claim Period for which a claim was submitted since the date of admission. The IRO shall review medical records for the Medicare beneficiaries selected based on the supporting documentation available at HOK’s offices or under HOK’s control and applicable billing and coding regulations and guidance to determine whether the Medicare or Medicaid beneficiary was eligible for the hospice benefit during each Claim Period. For any beneficiary in the Beneficiary Sample that results in a determination by the IRO that the beneficiary was not eligible for the hospice benefit during the Claim Period, the IRO shall perform a review of the system(s) and process(es) that resulted in XXX’s erroneous determination that the beneficiary was eligible for the hospice benefit, to identify any problems or weaknesses that may have resulted in the identified error(s). The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) for determining eligibility for the hospice benefit.
Eligibility Review. The IRO shall select a Beneficiary Sample. The IRO shall review the medical records of the Medicare beneficiaries in the Beneficiary Sample to determine whether the beneficiaries were eligible for hospice services for each Claim Period for which a claim was submitted since the date of admission. The IRO shall review medical records for the Medicare beneficiaries selected based on the supporting documentation available at Hospicio’s offices or under Hospicio’s control and applicable billing and coding regulations and guidance to determine whether the Medicare beneficiary was eligible for the hospice benefit during each Claim Period.
Eligibility Review. Vendor shall initiate the eligibility determination workflow and ensure the appropriate step (e.g., Florida KidCare Application received, under review, pending information, eligibility approved, enrollment pending payment, enrolled) is reflected in the CRM System. Vendor shall notify the Customer if any additional information is required to complete the eligibility determination. Vendor shall apply any new information received to the Family Account. Vendor shall follow business rules codified in a business rules engine to screen for potential Medicaid eligibility and determine eligibility for the Program. Customers may submit documents affecting their eligibility status at any time during their 12- month continuous eligibility period. Vendor shall conduct an eligibility review at that time.
Eligibility Review. Verify that discounted college month and/or semester passes are only sold to students who meet the eligibility requirement for enrollment, as set forth by MTS Fare Ordinance No. 4. This includes students with a current enrollment for seven (7) units or more, or the equivalent non-unit hours, at an accredited post-secondary school.
