Quantitative Results Sample Clauses

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Prime. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to Prime. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to Prime. iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌ v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌ vi. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viii. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.‌
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Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Progenity differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Progenity. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to Progenity. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that did not have appropriate documentation of medical necessity and resulted in an Overpayment to Progenity. iv. Total dollar amount of all Overpayments in the Claims Review Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample. vi. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viii. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Hill-Rom (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Hill- Rom. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.
Quantitative Results i. Total number and percentage of instances in which the Billing IRO determined that the Paid Claims submitted by Parkland (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Parkland. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of Paid Claims included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the Billing IRO), correct allowed amount (as determined by the Billing IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.
Quantitative Results. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Extendicare (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Dignity Health (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Dignity Health. iii. Total dollar amount of all Overpayments in each Discovery Sample and each Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in each Discovery Sample and each Full Sample (if applicable) and the net Overpayment associated with each Discovery Sample and each Full Sample (if applicable). v. Error Rate in each Discovery Sample and each Full Sample (if applicable). vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by xxxxx, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount. vii. If a Full Sample is performed, the methodology used by the IRO to estimate the actual Overpayment in the Population and the amount of such Overpayment.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by the Friendship Entities (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to the Friendship Entities. iii. Total dollar amount of all Overpayments in the Discovery Samples and the Full Samples (if applicable). iv. Total dollar amount of Paid Claims included in the Discovery Samples and the Full Samples and the net Overpayment associated with the Discovery Samples and the Full Samples. v. Error Rate in the Discovery Samples and the Full Samples. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount. vii. If any Full Samples are performed, the methodology used by the IRO to estimate the actual Overpayment in the Population and the amount of such Overpayment.
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Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Provider differed from what should have been the correct coding. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary. iv. Total dollar amount of Paid Claims included in the Claims Review Sample and the net Overpayment associated with the Claims Review Sample. v. Error Rate in the Claims Review Sample.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Rotech (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Rotech. iii. Total dollar amount of all Overpayments in the sample. iv. Total dollar amount of paid Items included in the sample and the net Overpayment associated with the sample. v. Error Rate in the sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim appraised: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount. (See Attachment 1 to this Appendix.)
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by the U.S. Healthcare Supply DMEPOS Companies differed from what should have been the correct coding and in which such difference resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented and in which such documentation errors resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items or services that were not medically necessary and resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim did not comply with the DMEPOS telemarketing rules found at 42 C.F.R. § 424.57(c)(11), regardless of whether it resulted in an Overpayment to the U.S. Healthcare Supply DMEPOS Companies. v. Total dollar amount of all Overpayments in the Claims Review Sample. vi. Total dollar amount of Paid Claims included in the Claims Review Sample. vii. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample. viii. An estimate of the actual Overpayment in the Population at the mean point estimate. ix. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.
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