Claims Review Sample Clauses

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 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 review Orbit’s 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. The IRO shall review claims submitted by 21st Century and reimbursed by the Medicare and 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 C to this CIA, which is incorporated by reference.
Claims Review. The IRO shall perform the Skilled Nursing Facility Claims Review (Claims Review) annually to cover each Reporting Period. The Claims Review shall be conducted at five NAHC facilities (“Subject Facilities”), for each Reporting Period. The IRO shall perform all components of each Claims Review.
Claims Review. The IRO shall conduct a review of Casey Pharmacy’s claims submitted to and reimbursed by the Medicare and Medicaid programs, to determine whether: (1) the prescription drugs furnished by Casey Pharmacy were dispensed according to a valid prescription, (2) Casey Pharmacy maintained appropriate documentation of a valid prescription for each drug dispensed (including any refills of such prescription), (3) the claims were correctly billed and reimbursed, and (4) Casey Pharmacy appropriately collected or waived cost-sharing amounts, 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 conduct a review of Dr. Villegas’s coding, billing, and claims submission to the Medicare and state Medicaid 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 submittedto 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 appropriate classification under the Plan of Allocation. The Settlement Administrator shall reject any Claim that does not comply in any material respect with the instructions on the Claim 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 shall confirm that all persons who submit Claims either (a) received Email Notice or Supplemental Postcard Notice or (b) submitted a proof of purchase for their Nexus 6P. The Settlement Administrator shall cross-reference Claims against lists of Settlement Class Members provided by Class Counsel, Huawei and Google in accordance with § 4.1.3. The Settlement Administrator shall cross-reference Claims against information provided by Google to determine, to the extent possible, whether the Claimants who purchased a Nexus 6P from Google received a Pixel XL as a replacement device for a Nexus 6P. The Settlement Administrator shall cross- reference Claims in Group 3, as defined in the Plan of Allocation, against information provided by Google to determine, to the extent possible, whether Claimants in Group 3 who purchased a Nexus 6P from Google received a Nexus 6P as a replacement device for a Nexus 6P. The decision of the Settlement Administrator shall be final as to the determination of the Claimant’s recovery, subject to § 3.6 below.
Claims Review. In any case in which a claim for Plan benefits of a Member or beneficiary is denied or modified, the Committee shall furnish written notice to the claimant within ninety days (or within 180 days if additional information requested by the Committee necessitates an extension of the ninety-day period), which notice shall: