Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2018 cost reports and MCP surveys. We adjusted encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPs.
Appears in 3 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third third-party liability (TPL) and fraud recoveries based on data available in CY 2018 cost reports and MCP surveys. We adjusted encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPs2024 Annual MCOP surveys submissions.
Appears in 2 contracts
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2018 2017 cost reports and MCP surveys. These data sources indicated that approximately 0.3% of total claims were recovered and not reflected in the baseline experience data. We adjusted encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPs.
Appears in 2 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2018 2019 cost reports and MCP surveys. We adjusted encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPs.
Appears in 2 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2018 2019 cost reports and MCP MCOP surveys. We Adjustments made to base data Upon review of 2019 cost reports and MCOP surveys, we adjusted encounter baseline the base data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by for the MCPs.following items: ◾ Pharmacy Rebates ◾ Net Reinsurance
Appears in 1 contract
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
Third Party Liability/Fraud and Abuse. In addition to actual cost avoidance reflected in the encounter data, we estimated additional third party liability (TPL) and fraud recoveries based on data available in CY 2018 2019 cost reports and MCP surveys. We adjusted encounter baseline data by region to reflect an estimated amount of TPL and fraud recoveries using data reported by the MCPsMCOs.
Appears in 1 contract
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan
