Common use of Quantitative Results Clause in Contracts

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 Dignity Health or on behalf of CCH of New York (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 HealthCCH of New York. iii. Total dollar amount of all Overpayments in each the Discovery Sample and each the Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in each the Discovery Sample and each the Full Sample (if applicable) and the net Overpayment associated with each the Discovery Sample and each the Full Sample (if applicable)Sample. v. Error Rate in each the Discovery Sample and each the Full Sample (if applicable)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 xxxxxpayor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), and the dollar difference between the allowed amount reimbursed by the 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 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 the Discovery Sample and each the Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in each the Discovery Sample and each the Full Sample (if applicable) and the net Overpayment associated with each the Discovery Sample and each the Full Sample (if applicable)Sample. v. Error Rate in each the Discovery Sample and each the Full Sample (if applicable)Sample. vi. A spreadsheet of the Claims Inpatient Medical Necessity and Appropriateness 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 xxxxxpayor, 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 Dignity Health Xxxxxxxx (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 HealthXxxxxxxx. iii. Total dollar amount of all Overpayments in each the Discovery Sample Samples and each the Full Sample Sample(s) (if applicable). iv. Total dollar amount of Paid Claims included in each the Discovery Sample Samples and each the Full Sample (if applicableSample(s) and the net Overpayment associated with each the Discovery Sample Samples and each the Full Sample (if applicableSample(s). v. Error Rate in each the Discovery Sample Samples and each the Full Sample (if applicableSample(s). 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 xxxxxpayor, 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 Dignity Health (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the paymentcoding and in which such difference resulted in an Overpayment. ii. Total number and percentage of instances in which the IRO determined that a Paid Claim Submitted differed from the Correct Claim was not appropriately documented and in which such difference documentation errors resulted in an Overpayment to Dignity HealthOverpayment. 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. iv. Total dollar amount of all Overpayments in each Discovery Sample and each Full Sample (if applicable)the Claims Review Sample. iv. v. 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)Claims Review Sample. v. vi. Error Rate in each Discovery the Claims Review Sample. The Error Rate shall be calculated by dividing the Overpayment in the Claims Review Sample and each Full Sample (if applicable)by the total dollar amount associated with the Paid Claims in the Claims Review Sample. vivii. 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 xxxxxpayor, 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.