Future Reimbursement Accuracy Optimization Processes Sample Clauses

Future Reimbursement Accuracy Optimization Processes. (“FRO Processes”): Inovalon will utilize Health Plan Data Sets to perform CARA processes on a 12-month date of service period (a “FRO Process DOS Period”) utilized for the submission of data to CMS (on or before the respective deadline, referred to as the respective “FRO Process CMS Submission Deadline”) for the setting of reimbursement rates for a respective Future Reimbursement Payment Period (each a “FRO Process Payment Period”). i. Each FRO Process DOS Period consists of a period of 12 consecutive calendar months, beginning either on January 1st or July 1st of each year. The FRO Process associated with the FRO Process DOS Periods beginning on January 1st will be referred to as the “FRO 1 Process” and the FRO Process associated with the FRO Process DOS Periods beginning July 1st will be referred to as the “FRO 2 Process.” The first FRO Process DOS Period for which CARA processes are to be undertaken under this Agreement is: 1/1/15 to 12/31/15. ii. Each FRO Process CMS Submission Deadline occurs on the first Friday in March (for FRO Process DOS Periods ending the preceding December 31st) or the first Friday in September (for FRO Process DOS Periods ending the preceding June 30th), as the case may be, following the respective FRO Process DOS Period. For sake of example, the FRO Process CMS Submission Deadline for the submission of all data associated with the first FRO Process DOS Period processed under this Agreement is: 3/4/16. iii. Each review of a FRO Process DOS Period and data submitted by the respective FRO Process CMS Submission Deadline is utilized by CMS to set reimbursement rates for the Client for the next full six consecutive month period (i.e., either January through June or July through December, as the case may be). For sake of example, the period for which the first FRO Process DOS Period processed under this Agreement impacts reimbursement (the respective FRO Process Payment Period) is: 7/1/16 to 12/31/16. Statement of Work #4 –Capitation Risk Adjustment (CARA®) Scope of Services iv. The CARA FRO Processes period associated with each FRO Process DOS Period (each a “CARA FRO Processes Period”) begins on the 15th day of the twelfth month of the respective FRO Process DOS Period and concludes on the respective FRO Process CMS Submission Deadline. For sake of example, the first CARA FRO Processes Period will generally begin 12/15/15 (or upon commencement of this Agreement, as the case may be) and would conclude on the first FRO Process CMS S...