Paid Claim definition

Paid Claim means a fee-for-service claim submitted by Provider and for which Provider has received reimbursement from the Medicare program.

Paid Claim means a fee-for-service claim submitted by Xxxxx and for which Xxxxx has received reimbursement from the Medicare program.‌

Paid Claim means a Claim that has been paid (net of any adjustments) and not reversed, denied or voided; and which includes Zero Balance Claims not reversed, denied, or voided.

Examples of Paid Claim in a sentence

• The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample.

• A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

• The IRO shall provide its observations and recommendations on suggested improvements to the system(s) and the process(es) that generated the Paid Claim.

• For each Paid Claim in the Claims Review Sample that results in an Overpayment, the IRO shall review the system(s) and process(es) that generated the Paid Claim and identify any problems or weaknesses that may have resulted in the identified Overpayments.

• A spreadsheet of the Quarterly Claims Sample results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, procedure code submitted, procedure code reimbursed, allowed amount reimbursed by payor, correct procedure code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount.

More Definitions of Paid Claim

Paid Claim means a Claim that meets coverage requirements and is subsequently paid. All Claims with an associated Rejected Claim, Reversed Claim, or Duplicate Claim shall not be considered Paid Claims and are excluded from the financial and/or service fee considerations.

Paid Claim means a claim authorised by the Claims Department in respect of repair costs relating to the primary cause of a breakdown attended by the AA under Your AA Fleet Breakdown Cover.

Paid Claim means a claim by a covered person for payment of benefits under a health benefits plan for which the financial obligation for the payment of the claim under the contract rests upon and has been paid by the carrier, excluding claims adjustment expenses.

Paid Claim means a fee-for-service claim submitted by CHN and for which XXX has received reimbursement from the Medicare program.

Paid Claim means each drug Claim that is dispensed to a member and paid by the Sponsor or member, and shall not include any denied Claims. With respect to any dispensed and paid Claim, if the Claim is adjusted in any way, the Claim shall constitute only one Paid Claim.

Paid Claim means a claim submitted by Xxxxxxx and for which Xxxxxxx has received reimbursement from the Medicare program or a Medicare Advantage Organization (MAO). A claim that has been refunded to or recouped by the Medicare program or an MAO or is in the process of being refunded or recouped shall not be considered to be a Paid Claim.

Paid Claim has the meaning given to it in paragraph 3(b)(i) of Schedule 6;