Service Category 3 – Claims Auditing Tasks Sample Clauses

Service Category 3 – Claims Auditing Tasks among others that the tasks that may be permissible for Service Category 3 include, but are not limited to: “Audit Customer information processed during the audit periodThe services sought in this procurement are for statewide use by any eligible Customer. Customer information and the time period(s) will be defined by the Customer specific scope of work. The Department of Management Services Division of State Group Insurance has previously requested post payment audits of medical and pharmacy claims. Please provide a sample or further explanation of “Customer information” What time period(s) would be subject to “Audit”? The Department of Management Services has previously defined an audit period as July 1st through June 30th of a year.
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Service Category 3 – Claims Auditing Tasks. Tasks that may be permissible for Service Category 3 include, but are not limited to: • Audit Customer information processed during audit period. • Operational assessment of administrative operations. • Evaluate compliance with statutory, regulatory, and contractual requirements. • Proactively search for potential fraud and abuse.

Related to Service Category 3 – Claims Auditing Tasks

  • Technical Objections to Grievances It is the intent of both Parties of this Agreement that no grievance shall be defeated merely because of a technical error, other than time limitations in processing the grievance through the grievance procedure. To this end, an arbitration board shall have the power to allow all necessary amendments to the grievance and the power to waive formal procedural irregularities in the processing of a grievance, in order to determine the real matter in dispute and to render a decision according to equitable principles and the justice of the case.

  • Statement of Grievance The grievance shall contain a statement of: 1. Specific situation, act or acts complained of as violation of this Agreement, or written rules, regulations or policies; 2. The damage suffered by the employee; and 3. The relief sought.

  • Submission of Grievances A. Any employee or group of employees shall have the right to present a grievance. No employee or group of employees shall be hindered from or disciplined for exercising this right. B. If any two (2) or more employees have essentially the same grievance they may, and if requested by the County must, collectively present and pursue their grievance if they report to the same immediate supervisor. C. If the grievant is a group of more than three (3) employees, the group shall, at the request of the County, appoint one (1) or two (2) employees to speak for the collective group. To be considered a grievant in a group grievance, each employee must be individually identified as a grievant when the grievance is submitted at Step 2.

  • Contractor Certification for Contractor Employees Introduction Texas Education Code Chapter 22 requires entities that contract with school districts to provide services to obtain criminal history record information regarding covered employees. Contractors must certify to the district that they have complied. Covered employees with disqualifying criminal histories are prohibited from serving at a school district. Definitions: Covered employees: Employees of a contractor or subcontractor who have or will have continuing duties related to the service to be performed at the District and have or will have direct contact with students. The District will be the final arbiter of what constitutes direct contact with students. Disqualifying criminal history: Any conviction or other criminal history information designated by the District, or one of the following offenses, if at the time of the offense, the victim was under 18 or enrolled in a public school: (a) a felony offense under Title 5, Texas Penal Code; (b) an offense for which a defendant is required to register as a sex offender under Chapter 62, Texas Code of Criminal Procedure; or (c) an equivalent offense under federal law or the laws of another state. I certify that: NONE (Section A) of the employees of Contractor and any subcontractors are covered employees, as defined above. If this box is checked, I further certify that Contractor has taken precautions or imposed conditions to ensure that the employees of Contractor and any subcontractor will not become covered employees. Contractor will maintain these precautions or conditions throughout the time the contracted services are provided. OR SOME (Section B) or all of the employees of Contractor and any subcontractor are covered employees. If this box is checked, I further certify that: (1) Contractor has obtained all required criminal history record information regarding its covered employees. None of the covered employees has a disqualifying criminal history.

  • Office of Inspector General Investigative Findings Expert Review In accordance with Senate Bill 799, Acts 2021, 87th Leg., R.S., if Texas Government Code, Section 531.102(m-1)(2) is applicable to this Contract, Contractor affirms that it possesses the necessary occupational licenses and experience.

  • Patent Filing Responsibilities and Costs 1. The invention and patent rights herein apply to any patent application or patents covering an invention made under this Agreement. Each Party is responsible for its own costs of obtaining and maintaining patents covering sole inventions of its employees. The Parties may agree otherwise, upon the reporting of any invention (sole or joint) or in any license granted. 2. Partner shall include the following in patent applications for an invention made jointly between NASA employees, its Related Entity employees and Partner employees: The invention described herein may be manufactured and used by or for the U.S. Government for U.S. Government purposes without the payment of royalties thereon or therefore.

  • Service Calls What is a Service Call? Do You have to pay anything for a Service Call? When can You request a Service Call? How can You request a Service Call? What is the Covered Repair Guarantee? When does this Service Agreement start and how long is it? Can You cancel? Can We cancel? Will this Service Agreement automatically renew? Unless You tell Us otherwise, Your Service Agreement will automatically renew at the end of every Term for another 12 months at the then-current renewal price. We may change the price at renewal. We reserve the right to not offer this Service Agreement upon renewal. How can You contact NAW? Receiving documents electronically Privacy policy Assignment/Amendment Transfer

  • Claims Review Methodology ‌‌ a. C laims Review Population. A description of the Population subject‌‌ to the Quarterly Claims Review.

  • Service Level Expectations Without limiting any other requirements of the Agreement, the Service Provider shall meet or exceed the following standards, policies, and guidelines:

  • Criminal History Category With regard to determining defendant’s criminal history points and criminal history category, based on the facts now known to the government, defendant’s criminal history points equal zero and defendant’s criminal history category is I.

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