Examples of Paid claims in a sentence
The IRO shall select a random sample of 100 Paid Claims (Claims Review Sample).
The IRO shall request all documentation and materials required for its review of the Paid Claims in each Quarterly Claims Sample and Practitioner shall furnish such documentation and materials to the IRO, prior to the IRO initiating its review of the Quarterly Claims Sample.
The IRO shall review the Paid Claims based on RAPHA’s documentation and the applicable Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.
The first set of Paid Claims selected shall be used for the Claims Review Sample (i.e., it is not permissible to generate more than one list of random samples and then select one for use).
The IRO shall review the Paid Claims based on CFS’s documentation and the applicable Medicaid program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.