Common use of Quantitative Results Clause in Contracts

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.‌

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime CHSI differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeCHSI. 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 PrimeCHSI. 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 PrimeCHSI. 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 coding of the Paid Claims submitted by Prime LCCA differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeLCCA. 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 PrimeLCCA. 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 PrimeLCCA. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items and services that were not appropriate and sufficient to meet the needs of a patient in the assigned Case Mix Groups and resulted in an Overpayment to LCCA. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample.‌Sample. v. vi. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Sample. vivii. 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. viiviii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiiix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG 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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime MCCG (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeMCCG. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime Xxxxxxxxxx-Xxxxxxx Xxxxxx differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeXxxxxxxxxx-Xxxxxxx Xxxxxx. 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 PrimeXxxxxxxxxx-Xxxxxxx Xxxxxx. 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 PrimeXxxxxxxxxx-Xxxxxxx Xxxxxx. iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Tri- County (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeTri- County. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime UCI differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeUCI. 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 PrimeUCI. 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 PrimeUCI. iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Providence differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeProvidence. 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 PrimeProvidence. 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 PrimeProvidence. 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.Sample.‌ vii. An estimate of the actual Overpayment in the Population at the mean point estimate.estimate.‌ viii. A spreadsheet of the Claims Review results that includes the following information for each 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 payorxxxxx, 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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime PGS differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimePGS. 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 PrimePGS. 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 PrimePGS. iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime in any Claims Review Sample differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeVibra. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim in any Claims Review Sample was not appropriately documented and in which such documentation errors resulted in an Overpayment to PrimeVibra. iii. Total number and percentage of instances in which the IRO determined that a Paid Claim in any Claims Review Sample was for items or services that were not medically necessary and resulted in an Overpayment to PrimeVibra. iv. Total dollar amount of all Overpayments identified in the each Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the each Claims Review Sample.‌Sample. vi. Error Rate in the Claims Review Sample. The For each Claims Review Sample, the Error Rate shall be calculated by dividing the Overpayment the total dollar amount of all Overpayments identified in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the respective 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 ClaimClaim in each Claims Review Sample: 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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime OC or Xxxxxx differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeOC or Xxxxxx. 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 PrimeOC or Xxxxxx. 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 PrimeOC or Xxxxxx. iv. Any instances in which the dosage amount(s) of administered pharmaceuticals billed on a Paid Claim is inconsistent with the available inventory for such pharmaceutical. v. Total dollar amount of all Overpayments in the Quarterly Claims Review Sample.‌Sample. v. vi. Total dollar amount of Paid Claims included in the Quarterly Claims Review Sample.‌Sample. vivii. Error Rate in the Quarterly Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Quarterly Claims Review Sample by the total dollar amount associated with the Paid Claims in the Quarterly Claims Review Sample. viiviii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiiix. A spreadsheet of the Quarterly Claims Review Sample results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted (e.g.submitted, DRG, CPT code, etc.), 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.‌amount.

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 PrimeOverpayment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately 52 documented and in which such documentation errors resulted in an Overpayment to PrimeOverpayment. 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 PrimeOverpayment. iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime NAHC differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeNAHC. 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 PrimeNAHC. 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 PrimeNAHC. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items and services that were not appropriate and sufficient to meet the needs of a patient in the assigned Case Mix Groups and resulted in an Overpayment to NAHC. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample.‌Sample. v. vi. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Sample. vivii. 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. viiviii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiiix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG 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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Gamma differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeGamma. 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 PrimeGamma. 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 PrimeGamma. 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 coding of the Paid Claims submitted by Prime Essex differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeEssex. 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 PrimeEssex. 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 PrimeEssex. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items and services that were not appropriate and sufficient to meet the needs of a patient in the assigned Case Mix Groups and resulted in an Overpayment to Essex. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample.‌Sample. v. vi. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Sample. vivii. 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. viiviii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiiix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG 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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Provider (Submitted Claim) differed from what should have been the correct coding claim (Correct Claim) and in which such difference resulted in an Overpayment to PrimeProvider. ii. Total number and percentage of instances in which the IRO determined that Provider did not maintain adequate documentation of a prescription drug (or refill) for which a Paid Claim was not appropriately documented submitted and in which such documentation errors resulted in an Overpayment to PrimeProvider. 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 PrimeProvider. iv. Total dollar amount of all Overpayments in the Quarterly Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Quarterly Claims Review Sample.‌Sample. vi. Error Rate in the Quarterly Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Quarterly Claims Review Sample by the total dollar amount associated with the Paid Claims in the Quarterly Claims Review Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viii. A spreadsheet of the Quarterly Claims Review Sample results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, national drug code submitted (e.g.submitted, DRGquantity prescribed, CPT codequantity dispensed, etc.)quantity billed, code reimbursed, allowed amount reimbursed by payor, correct code amount reimbursed (as determined by the IRO), correct allowed amount (as determined by the IRO), and any dollar difference between allowed amount reimbursed by payor and the correct allowed amount.‌amount reimbursed (as determined by the IRO).

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime USPh (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeUSPh. 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.‌Discovery Samples and the Full Samples (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Samples and the Full Samples and the net Overpayment associated with the Discovery Samples and the Full Samples. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Samples and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review SampleFull Samples. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌amount. vii. If any Full Samples are performed, the methodology used by the IRO to estimate the actual Overpayment in Population 1 or Population 2 (on a per-Clinic basis) and the amount of such Overpayment.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Baptist (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeBaptist. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime APM, Park Center, or Xxxxxx differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeAPM, Park Center, and Xxxxxx. 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 PrimeAPM, Park Center, and Xxxxxx. 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 PrimeAPM, Park Center, and Xxxxxx. 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 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 PrimeXxxxxxx. 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 PrimeXxxxxxx. 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 PrimeXxxxxxx. iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Toccoa (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeToccoa. 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.‌Discovery Samples and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Discovery Samples and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample.‌ vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Samples and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Sample.Full Sample.‌ vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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 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 coding of the Paid Claims submitted by Prime Trans-Star (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeTrans- Star. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime Ocean Dental (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeOcean Dental. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime Amedisys (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeAmedisys. 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.‌Discovery Sample and the Full Sample (if applicable). Amedisys, Inc. and Amedisys Holding, LLC Corporate Integrity Agreement Appendix B v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime Home Bound (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeHome Bound. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime La Fuente (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeLa Fuente. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime CHSI differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeCHSI. 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 PrimeCHSI. 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.CHSI. Community Health Systems, Inc. Corporate Integrity Agreement, Amended – Appendix B iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime First Call (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeFirst Call. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime CareMed (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeCareMed. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. Corporate Integrity Agreement between the Office of Inspector General and Sorkin’s Rx Ltd. d/b/a CareMed Pharmaceutical Services vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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, national drug code (NDC) and amount dispensed, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursedamount claimed, 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.‌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 coding of the Paid Claims submitted by Prime FHS differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeFHS. 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 PrimeFHS. 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 PrimeFHS. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items and services that were not appropriate and sufficient to meet the needs of a patient in the assigned Case Mix Groups and resulted in an Overpayment to FHS. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample.‌Sample. v. vi. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Sample. vivii. 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. viiviii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiiix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG 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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Southern States (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeSouthern States. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime Signature differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeSignature. 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 PrimeSignature. 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 PrimeSignature. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items and services that were not appropriate and sufficient to meet the needs of a patient in the assigned Case Mix Groups and resulted in an Overpayment to Signature. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample.‌Sample, if any. v. vi. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Sample, if any. vivii. Error Rate in the Claims Review Sample, if any. 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. viiviii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiiix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG 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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime PALMS (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimePALMS. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. 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.‌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 coding of the Paid Claims submitted by Prime Saber differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeSaber. 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 PrimeSaber. 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 PrimeSaber. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items and services that were not appropriate and sufficient to meet the needs of a patient in the assigned Case Mix Groups and resulted in an Overpayment to Saber. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample.‌Sample. v. vi. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Sample. vivii. 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. viiviii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiiix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG 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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime MCCG (Claim Submitted) differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Primeclaim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim was not appropriately documented Submitted differed from the Correct Claim and in which such documentation errors difference resulted in an Overpayment to PrimeMCCG. 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.‌Discovery Sample and the Full Sample (if applicable). v. iv. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample. vi. v. Error Rate in the Claims Review Sample. The Error Rate shall be calculated by dividing Discovery Sample and the Overpayment in the Claims Review Sample by the total dollar amount associated with the Paid Claims in the Claims Review Full Sample. vii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiivi. A spreadsheet of the Claims Inpatient Medical Necessity and Appropriateness Review results that includes the following information for each Paid Claim: the IRO’s determination regarding whether the inpatient admission and length of stay were medically necessary and appropriate and, for any inpatient admission that the IRO determines was not medically necessary and appropriate, the following information: 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.‌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 coding of the Paid Claims submitted by Prime UMHS differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeUMHS. 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 PrimeUMHS. 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 PrimeUMHS. iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Health Quest differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeHealth Quest. 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 PrimeHealth Quest. 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 PrimeHealth Quest. iv. Total dollar amount of all Overpayments in the Claims Review Sample.‌Sample. v. Total dollar amount of Paid Claims included in the Claims Review Sample.‌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.‌amount.

Quantitative Results. ‌‌ i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Prime Longwood differed from what should have been the correct coding and in which such difference resulted in an Overpayment to PrimeLongwood. 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 PrimeLongwood. 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 PrimeLongwood. iv. Total number and percentage of instances in which the IRO determined that a Paid Claim was for items and services that were not appropriate and sufficient to meet the needs of a patient in the assigned Case Mix Groups and resulted in an Overpayment to Longwood. v. Total dollar amount of all Overpayments in the Claims Claim Review Sample.‌Sample. v. vi. Total dollar amount of Paid Claims included in the Claims Review Sample.‌Sample. vivii. 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. viiviii. An estimate of the actual Overpayment in the Population at the mean point estimate. viiiix. A spreadsheet of the Claims Review results for each Subject Facility that includes the following information for each selected Patient Stay and the associated Paid ClaimClaims: the Federal health care program billed, ; beneficiary health insurance claim number, date dates of service, code submitted (e.g., DRG, CPT PDPM or RUG 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.‌amount.