Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Extendicare (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Dignity Health (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Xxxxx differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Xxxxx.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by CHN differed from what should have been the correct coding.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Progenity differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Progenity.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Xxxxxxxxxx was improperly coded, submitted, reimbursed, or was not medically necessary or appropriate (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by First Call (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment.
ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to First Call.
iii. Total dollar amount of all Overpayments in the Discovery Sample and the Full Sample (if applicable).
iv. Total dollar amount of Paid Claims included in the Discovery Sample and the Full Sample and the net Overpayment associated with the Discovery Sample and the Full Sample.
v. Error Rate in the Discovery Sample and the Full Sample.
vi. 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.
vii. If a Full Sample is performed, the methodology used by the IRO to estimate the actual Overpayment in the Population and the amount of such Overpayment.
Quantitative Results. For each Claims Review Sample, the IRO shall provide the following information:
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the coding of the Paid Claims submitted by Genova differed from what should have been the correct coding and in which such difference resulted in an Overpayment to Genova.
Quantitative Results i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Southern States (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment.
