Audit Claims definition
Examples of Audit Claims in a sentence
OIG will attempt in good faith to resolve any Internal Compliance Audit, Claims Review or Unallowable Cost Review issues with LHC prior to conducting a Validation Review.
To resolve any concerns raised by OIG, LHC may request a meeting with OIG to: (a) discuss the results of any Internal Compliance Audit, Claims Review or Unallowable Cost Review submissions or findings; (b) present any additional information to clarify the results of the Internal Compliance Audit, Claims Review or Unallowable Cost Review or to correct the inaccuracy of the Internal Compliance Audit, Claims Review or Unallowable Cost Review; and/or (c) propose alternatives to the proposed Validation Review.
The Arbitrator shall make a final determination of all Audit Claims and issue a final and binding arbitration award within 10 business days after the conclusion of the arbitration hearing.
All Audit Claims between the parties shall be determined by arbitration in accordance with the procedures set forth in Section 24.b(ii), above, subject to the following: The claimant ("Payee") will conduct an audit of the books of the other party ("Payor") pursuant to procedures set forth in the applicable agreement and present to the Payor an audit report setting forth the nature and amount of the Payee's Audit Claims in reasonable detail.
Notwithstanding anything herein to the contrary, no claim may be asserted against the Seller pursuant to Section 8.2(a)(vi) with respect to Audit Claims unless written notice of such claim is received by the Seller, prior to the 36 month anniversary of the Closing Date.
The parties shall then negotiate in good faith for a period ("Negotiating Period") of 10 business days from the date of the Payor's response with a view to resolving the Audit Claims.
The Plan Program Credit is only available from January 1, 2025 through December 31, 2025 for Contract Year 2 and January 1, 2026 through December 31, 2026 for Contract Year 3 and, subject to PBM approval, may be applied towards any documented expenses related to the combination of the following: Plan Communications, Clinical Programs, Pre or Post Implementation Audit, Claims Audit, and Additional Reporting or Data Feeds.
During the period between the end of the Negotiating Period and the commencement of the arbitration hearing, the Arbitrator shall engage an independent accountant ("Accounting Master") to review any and all accounting books and records of the Payor available for audit under the provisions of the applicable agreement and deemed relevant by the Accounting Master in order to resolve the Audit Claims.
If any applicable Audit Claims are not resolved within the Negotiating Period, such Audit Claims will be resolved in accordance with the procedures of Section 24.b(ii), above, except for the following: The arbitration hearing shall commence within 30 days after expiration of the Negotiating Period.
The award of the Arbitrator with respect to Audit Claims shall not be subject to any right of appeal.