Claims Review. The IRO shall conduct a review of LFAC’s claims submitted to and reimbursed by the Medicare and Medicaid programs, to determine whether the items and services furnished were medically necessary and appropriately documented (including that the records underlying the claims have not been duplicated or cloned), and whether the claims were correctly coded, submitted, and reimbursed for each three-month period during the term of this IA (Quarterly Claims Review) and shall prepare a Quarterly Claims Review Report, as outlined in Appendix B to this IA, which is incorporated by reference. The first three-month period for purposes of the Quarterly Claims Review requirement shall begin 30 days after the Effective Date. Each Quarterly Claims Review Report shall be submitted to OIG within 60 days following the end of the three-month period covered by the Quarterly Claims Review.
Claims Review. The IRO shall perform the Claims Review annually to cover each of the five Reporting Periods. The IRO shall perform all components of each Claims Review.
Claims Review. The IRO shall review claims submitted by Healogics for services provided by physicians employed by Healogics or Healogics- Affiliated Physician Practice Entities and reimbursed by the Medicare and/or Medicaid programs, to determine whether the items and services furnished were medically necessary and appropriately documented and whether the claims were correctly coded, submitted and reimbursed (Claims Review) and shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.
Claims Review. The IRO shall review the Friendship Entities’ coding, billing, and claims submission to the Medicare and state Medicaid programs and the reimbursement received (Claims Review) and shall prepare a Claims Review Report, as outlined in Appendix B to this CIA, which is incorporated by reference.
Claims Review. Blue Shield reserves the right to review all claims to determine whether any exclusions or limitations apply.
Claims Review. 32.2.2.1 All complaints by individuals that they have not received their proper entitlement to benefits under the Benefit Plans shall be made to the Committee.
Claims Review. The IRO shall conduct a review of Choudhary- Rolla Neurology’s coding, billing, and claims submission to the Federal health care programs and the reimbursement received for each three-month period during the term of this IA (Quarterly Claims Review) and shall prepare a Quarterly Claims Review Report, as outlined in Appendix B to this IA, which is incorporated by reference. The first three- month period for purposes of the Quarterly Claims Review requirement shall begin 30 days after the Effective Date. Each Quarterly Claims Review Report shall be submitted to OIG within 60 days following the end of the three-month period covered by the Quarterly Claims Review.
Claims Review. The Settlement Administrator shall review all Claims to determine their validity and to which class (DSL Settlement Class or both DSL Settlement Class and ARL Settlement Class) each claimant belongs. The Settlement Administrator shall reject any Claim that does not comply in any material respect with the instructions on the form; is not submitted by a Settlement Class Member; is a duplicate of another Claim; is a fraudulent Claim; or is submitted after the Claims Deadline. The Settlement Administrator’s determination as to the validity of a claim shall be final, subject to § 3.6 below.
Claims Review. The IRO shall perform the Skilled Nursing Facility Claims Review (Claims Review) annually to cover each of the five Reporting Periods. The Claims Review shall be conducted at 5% of Sava’s facilities or at least 10 facilities, whichever is greater (“Subject Facilities”), for each Reporting Period. The IRO shall perform all components of each Claims Review.