Common use of Validation Review Clause in Contracts

Validation Review. In the event OIG has reason to believe that: (a) any Claims Review fails to conform to the requirements of this CIA; or (b) the IRO’s findings or Claims Review results are inaccurate, OIG may, at its sole discretion, conduct its own review to determine whether the Claims Review complied with the requirements of the CIA and/or the findings or Claims Review results are inaccurate (Validation Review). The Providers shall pay for the reasonable cost of any such review performed by OIG or any of its designated agents so long as it is initiated within one year after the Providers’ final submission (as described in Section II) is received by OIG. Prior to initiating a Validation Review, OIG shall notify the Providers in writing of its intent to conduct a Validation Review and the reasons OIG has determined a Validation Review is necessary. The Providers shall have up to 30 days following the date of the OIG’s written notice to submit a written response to OIG that includes any additional or relevant information to clarify the results of the Claims Review or to correct the inaccuracy of the Claims Review and/or to propose alternatives to the proposed Validation Review. OIG will attempt in good faith to resolve any Claims Review issues with the Providers prior to conducting a Validation Review. However, the final determination as to whether or not to proceed with a Validation Review shall be made at the sole discretion of OIG.

Validation Review. In the event OIG has reason to believe that: (a) any Claims Review fails to conform to the requirements of this CIA; or (b) the IRO’s findings or Claims Review results are inaccurate, OIG may, at its sole discretion, conduct its own review to determine whether the Claims Review complied with the requirements of the CIA and/or the findings or Claims Review results are inaccurate (Validation Review). The Providers Trans-Star shall pay for the reasonable cost of any such review performed by OIG or any of its designated agents so long as it is initiated within one year after the Providers’ Trans- Star’s final submission (as described in Section II) is received by OIG. Prior to initiating a Validation Review, OIG shall notify the Providers Trans-Star in writing of its intent to conduct a Validation Review and the reasons OIG has determined a Validation Review is necessary. The Providers Trans-Star shall have up to 30 days following the date of the OIG’s written notice to submit a written response to OIG that includes any additional or relevant information to clarify the results of the Claims Review or to correct the inaccuracy of the Claims Review and/or to propose alternatives to the proposed Validation Review. OIG will attempt in good faith to resolve any Claims Review issues with the Providers Trans-Star prior to conducting a Validation Review. However, the final determination as to whether or not to proceed with a Validation Review shall be made at the sole discretion of OIG.

Validation Review. In the event OIG has reason to believe that: (a) any Claims Review fails to conform to the requirements of this CIA; or (b) the IRO’s findings or Claims Review results are inaccurate, OIG may, at its sole discretion, conduct its own review to determine whether the Claims Review complied with the requirements of the CIA and/or the findings or Claims Review results are inaccurate (Validation Review). The Providers Ocean Dental shall pay for the reasonable cost of any such review performed by OIG or any of its designated agents so long as it is initiated within one year after the Providers’ Ocean Dental’s final submission (as described in Section II) is received by OIG. Prior to initiating a Validation Review, OIG shall notify the Providers Ocean Dental in writing of its intent to conduct a Validation Review and the reasons OIG has determined a Validation Review is necessary. The Providers Ocean Dental shall have up to 30 days following the date of the OIG’s written notice to submit a written response to OIG that includes any additional or relevant information to clarify the results of the Claims Review or to correct the inaccuracy of the Claims Review and/or to propose alternatives to the proposed Validation Review. OIG will attempt in good faith to resolve any Claims Review issues with the Providers Ocean Dental prior to conducting a Validation Review. However, the final determination as to whether or not to proceed with a Validation Review shall be made at the sole discretion of OIG.

Validation Review. In the event OIG has reason to believe that: (a) any Claims Review fails to conform to the requirements of this CIA; or (b) the IRO’s findings or Claims Review results are inaccurate, OIG may, at its sole discretion, conduct its own review to determine whether the Claims Review complied with the requirements of the CIA and/or the findings or Claims Review results are inaccurate (Validation Review). The Providers Tri-County shall pay for the reasonable cost of any such review performed by OIG or any of its designated agents so long as it is initiated within one year after the Providers’ Tri- County’s final submission (as described in Section II) is received by OIG. Prior to initiating a Validation Review, OIG shall notify the Providers Tri-County in writing of its intent to conduct a Validation Review and the reasons OIG has determined a Validation Review is necessary. The Providers Tri-County shall have up to 30 days following the date of the OIG’s written notice to submit a written response to OIG that includes any additional or relevant information to clarify the results of the Claims Review or to correct the inaccuracy of the Claims Review and/or to propose alternatives to the proposed Validation Review. OIG will attempt in good faith to resolve any Claims Review issues with the Providers Tri-County prior to conducting a Validation Review. However, the final determination as to whether or not to proceed with a Validation Review shall be made at the sole discretion of OIG.