Financial Accuracy. The percentage of total audited claim dollars shall be at least the percentage designated in Attachment A.
Financial Accuracy. At all times, Third Party Administrator shall maintain a financial accuracy rate of **** percent (****%) for all claims.
Financial Accuracy. At least ninety-nine (99%) percent level of financial accuracy. Financial accuracy means the claim dollars paid in the correct amount divided by the total claim dollars paid. See Section 230. Five thousand ($5,000) dollars for each percentage point for which the standard is not met in each month
Financial Accuracy. No certificate, financial statement, schedule or any other statement made or furnished to TMCC by or on behalf of Borrower in connection with this Agreement or any other Loan Document contains or will contain any materially untrue statement of fact or omits any material fact. All financial statements provided to TMCC have been prepared in accordance with generally accepted accounting principles applied on a consistent basis to prior periods and accurately and completely represent the financial conditions of Borrower as of their respective dates in all material respects. There are no facts known to Borrower which have not been disclosed in writing to TMCC which materially and adversely affect the business, properties, assets, operations or condition (financial or otherwise), affairs, or prospects of Borrower.
Financial Accuracy. The Company will maintain a Financial Accuracy rate of not less than *** for the Guarantee Period. Financial Accuracy is measured by collecting a statistically significant random sample of claims processed. The sample is reviewed to determine the percentage of claim dollars processed correctly out of the total claim dollars submitted for payment. The measurement will be done by the Company's standard internal quality assurance program based on a periodic audit of all claims processed by the Service Center team servicing the Employer. The overall Guarantee Period result is recalculated using the raw data for such period. Failure to maintain a Financial Accuracy rate of at least *** for the Guarantee Period will result in a Premium Credit in the maximum amount of ***, not including any Premium Credit available pursuant to section 4(e). Credits against this Performance Standard will be applied on a gradient as follows: *** paid correctly - *** *** paid correctly - *** *** paid correctly - *** *** paid correctly - *** Less than *** paid correctly - ***
Financial Accuracy. The Financial Accuracy is the measure of dollars paid correctly in connection with the claims sampled for an audit period expressed as a percent. Claim dollars shall be deemed to have been paid correctly when the check issued accurately reflects the amount of benefits payable under the plan for that claim. The percentage shall be determined by subtracting (i) amounts overpaid plus amounts underpaid among claims sampled for such audit period from, (ii) the total amount paid on the claims sampled for such audit period and dividing the difference by the total amount paid on the claims sampled for such audit period. Results are provided quarterly. Penalty is based on an annual average.
Financial Accuracy. UMR agrees that Claim payments, on an aggregated dollar basis, shall be ninety-nine percent (99%) accurate to the plan of benefits. If however, the financial accuracy falls below the agreed upon level, UMR will give a credit as stated on the table below. Financial Accuracy will be calculated by dividing the total audited dollars paid correctly by the total audited dollars processed. This will be measured on customer specific results. 99% or higher 0% 98.5% to 98.9% 1% 98.0% to 98.4% 2% Less than 98.0% 3%
Financial Accuracy. UMR agrees that Claim payments, on an aggregated dollar basis, shall be ninety-nine percent (99%) accurate to the plan of benefits. If however, the financial accuracy falls below the agreed upon level, UMR will give a credit as stated on the table below. Financial Accuracy will be calculated by dividing the total audited dollars paid correctly by the total audited dollars processed. This will be measured on department results. UMR's Performance Penalty 99% or higher 0% 98.5% to 98.9% 1% 98.0% to 98.4% 2% Less than 98.0% 3% II. Turnaround Time UMR agrees that ninety percent (90%) of all clean Claims will be processed within 10 business days from the date that UMR receives all information necessary to adjudicate the Claim. In the event that UMR's turnaround time falls below the agreed upon level, UMR will give a credit as stated on the table below.
1. Average speed-to-answer telephone calls UMR agrees that on average, calls will be answered in thirty (30) seconds or less. If calls are answered in more than thirty (30) seconds, UMR will give a credit as stated on the table below. UMR's Performance Penalty 30 seconds or less average 0% 31 to 45 seconds average 1% 46 seconds or higher average 2% 2. Abandonment Rate
