Quarterly Claims Sample Sample Clauses

Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 60 Paid Claims from the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.‌‌ b. PC, Xxxxx, and Bandar shall provide the IRO with a list of all PC, Xxxxx, and Bandar’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 60 random numbers using RAT-STATS and then use the random numbers to identify the 60 Paid Claims in the Population that will be subject to review by the IRO.‌ c. The randomly selected 60 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at PC, Xxxxx, and Bandar’s office or under PC, Xxxxx, and Bandar’s control and applicable Medicare and state Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌
Sample 1See All (53)
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Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of I&L during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat- stats/index.asp.‌‌‌ b. I&L shall provide the IRO with a list of all I&L’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Claims Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Claims Population that will be subject to review by the IRO.‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at I&L’s office or under I&L’s control and applicable Medicare and state Medicaid program requirements and applicable state Board of Pharmacy requirements to determine whether: (1) the prescription drugs furnished by I&L were dispensed according to a valid prescription,‌‌ (2) I&L maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such drug), and (3) whether the claims were correctly billed and reimbursed. For each Paid Claim reviewed, the IRO should verify that I&L maintained documentation of: (1) the prescription or order for the drug dispensed; (2) the delivery of the drug; and (3) any required steps to initiate and process a prescription refill. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section B below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌
Sample 1See All (13)
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xx. Xxxxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at‌‌ xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
Sample 1See All (6)
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Alaska Neurology during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. b. Alaska Neurology shall provide the IRO with a list of all Alaska Neurology’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Population that will be subject to review by the IRO. c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at Alaska Neurology’s office or under Alaska Neurology’s control and applicable Medicare and state Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.
Sample 1
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Klurfeld during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. x. Xxxxxxxx shall provide the IRO with a list of all Klurfeld’s Paid Claims for the three-month period covered by the Quarterly Claims
Sample 1
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Lan Apothecary during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.‌‌ b. Lan Apothecary shall provide the IRO with a list of all Lan Apothecary’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Population that will be subject to review by the IRO.‌ c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at Lan Apothecary’s location or under Lan Apothecary’s control and applicable Medicare and state Medicaid program requirements and applicable State Board of Pharmacy requirements to determine whether (i) each prescription drug furnished was dispensed according to a valid prescription, (ii) Lan Apothecary maintained appropriate documentation of a valid prescription for each prescription drug dispensed (including any refills), (iii) any prior authorization required by the payor was obtained, (iv) all cost sharing amounts were collected or waived in accordance with applicable payor requirements, and (v) the claim was correctly submitted and reimbursed.‌ d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.‌
Sample 1
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Khanna during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. x. Xxxxxx shall provide the IRO with a list of all Khanna’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Population that will be subject to review by the IRO. c. The randomly selected 30 Paid Claims shall be reviewed by the IRO based on the supporting documentation available at Khanna’s office or under Khanna’s control and applicable Medicare and TRICARE program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed. d. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.
Sample 1
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Related to Quarterly Claims Sample

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