AUDIT OR REVIEW. 10.1. The Department (or persons authorised by the Department) may conduct an audit or review of the RTO at any reasonable time:
AUDIT OR REVIEW. 11.1. The RTO acknowledges that, during the Term:
AUDIT OR REVIEW. Any payment is subject to appropriate adjustment if an audit or review demonstrates insufficient or inappropriate documentation to support a claims notification submitted to the Department. Exhibit B (3) Provider Pay for Performance Program The Provider Pay-for-Performance (P4P) program described in this Exhibit B (3) is for services rendered by providers during a Calendar Year (CY) and defined in your PH- MCO specific Quality Performance Program approved by the Department
AUDIT OR REVIEW. Any payment is subject to appropriate adjustment if an audit or review demonstrates insufficient or inappropriate documentation to support a claims notification submitted to the Department. Federal HC Agreements 13-14 Amendments Updated November 20, 2012 APPENDIX 3g OVERVIEW OF METHODOLOGIES FOR RATE SETTING AND DETERMINATION OF RISK SHARING WITHHOLD AMOUNTS
AUDIT OR REVIEW. Any payment is subject to appropriate adjustment if an audit or review demonstrates insufficient or inappropriate documentation to support a claims notification submitted to the Department. Federal HC Agreements 13-14 Amendment - NW & NE Updated October 21, 2013 APPENDIX 3k HIGH COST RISK POOL Overview The Department will establish, administer, and distribute funds from a quarterly High Cost Risk Pool (HCRP). This Appendix 3k is effective July 1, 2013 and supersedes any previous version to define the HCRP for the July-September 2013 quarter and each subsequent quarter. Each quarterly risk pool will be funded through High Cost Risk Pool Allocation Amounts (HCRPAA). After each quarter has ended, each PH-MCO will send the Department a file with information on high cost recipients during a twelve month period defined below. After repricing each inpatient claim to the amount the Department would have paid for the same admission, the Department will sum the amount spent by each PH-MCO in excess of the HCRP Threshold on each recipient for the Defined Twelve Month Period. The Department will distribute the funds in the HCRP in proportion to each PH-MCO’s adjusted expenditures in excess of the HCRP Threshold on all recipients for the Defined Twelve Month Period. The Department’s payment to each PH-MCO will be net of the PH-MCO’s HCRPAA obligation for the quarter. If the PH-MCO’s HCRPAA obligation exceeds its share of the HCRP, the Department will reduce a subsequent payment to the PH-MCO by the amount of the difference. The Department may elect to use PH-MCO encounter data in lieu of HCRP- specific files submitted by the MCOs, in whole or in part. PH-MCO Inclusion/exclusion The HCRP Threshold is $80,000. A PH-MCO will participate in a quarterly high cost risk pool if both of the criteria below are met: − The Department has made or will make Capitation payments to the PH-MCO for this HealthChoices zone for all three months during the quarter; and − The Department has made or will make Capitation payments to the PH-MCO under this Agreement or any other HealthChoices Agreement for this HealthChoices zone for all three months of each of the four previous quarters. The Department will deem this criterion to have been met if it was met by the PH- MCO or by a PH-MCO that operated in the same HealthChoices zone (“Previous PH-MCO”) if one of the following criteria is met: • The current PH-MCO purchased the assets or liabilities of the Previous PH- MCO; or • The Department t...
AUDIT OR REVIEW. 10.1. The Board/Council acknowledges that, during the Term:
AUDIT OR REVIEW. Manager and Developer shall hire a firm of independent certified public accountants of recognized standing in the restaurant industry to review the assets employed in the operation of the Restaurants and the liabilities incurred in connection therewith and the results of the operations, and cash flows of the Restaurants during each year of this Agreement.
AUDIT OR REVIEW. The Managers may select public accountants with expertise in the Company’s business to audit or review the books and records of the Company.
AUDIT OR REVIEW. 9.1 The Commission or persons authorised by the Commission may conduct a performance review or audit of the Board/Council at any reasonable time:
AUDIT OR REVIEW. (a) Each financial year, the Trustee must arrange for an audit of the financial statements and compliance with the Private ancillary fund guidelines by the Trust and the Trustee by a person registered as a company auditor in accordance with the Private ancillary fund guidelines.
