Payment Accuracy. The Procedural Accuracy is measured as a percentage of correct payments in random sampled claims in a given period. A payment shall be deemed correct when the amount of benefits paid accurately reflects the amount of benefits payable under the plan for that claim, including no payment. The percentage shall be determined by dividing (i) the number of correctly processed claims sampled for such period by, (ii) the total number of claims processed sampled for such period. Results are provided quarterly. Penalty is based on an annual average. 98% of Claims free of payment error as related to total claims paid.
Appears in 5 contracts
Samples: Administrative Services Agreement, Administrative Services Agreement, Administrative Services Agreement
