FORECASTED CLAIMS/ENCOUNTERS Sample Clauses

FORECASTED CLAIMS/ENCOUNTERS. 8.1. The Department has forecasted claims and Encounters for the anticipated term of this Contract. These forecasts are intended to be used by the Parties as informational resources to anticipate growth in claims and Encounters and as a baseline for the Contractor to request a Contract change as described in Section 7.G, Option to Increase or Decrease Statewide Quantity of Service, of this Contract. The annual forecasted claims/Encounters are shown in the following table:
Sample 1
AutoNDA by SimpleDocs
FORECASTED CLAIMS/ENCOUNTERS. 8.1. The Department has forecasted claims and Encounters for the anticipated term of this Contract. These forecasts are intended to be used by the Parties as informational resources to anticipate growth in claims and Encounters and as a baseline for the Contractor to request a Contract change as described in Section 7.G, Option to Increase or Decrease Statewide Quantity of Service, of this Contract. The annual forecasted claims/Encounters are shown in the following table: Forecasted Claims/Encounters Table SFY Annual Claim/Encounter Volume SFY 2016-17 57,000,000 SFY 2017-18 58,000,000 SFY 2018-19 58,000,000 SFY 2019-20 58,000,000 SFY 2020-21 58,000,000 SFY 2021-22 59,000,000 SFY 2022-23 59,000,000 SFY 2023-24 59,000,000 This table includes paid and denied Fee-for-Service (FFS) medical, dental and pharmacy claims, capitations, and encounters as processed by the PBMS or MMIS contractor and available to the Department to query and report from the BIDM. The volume does not include claims that are rejected by the PBMS or MMIS contractor for data that is missing or invalid or out of compliance. The Department will provide the prior State Fiscal Year’s Annual Claim/Encounter Volume to the Contractor in the third quarter of each calendar year. Upon request from the Contractor, the Department will provide any support materials on how the data was calculated.
Sample 1

Related to FORECASTED CLAIMS/ENCOUNTERS

  • Claims Review Population A description of the Population subject to the Claims Review.

  • Disputed Claims 4.1 Notwithstanding paragraph 4.5 of this Schedule, payment by the Authority of all or any part of any invoice rendered or other claim for payment by the Contractor shall not signify approval of such invoice/claim. The Authority reserves the right to verify invoices/claims after the date of payment and subsequently to recover any sums which have been overpaid.

  • Claims Review Objective A clear statement of the objective intended to be achieved by the Claims Review.

  • Claims Review Report The IRO shall prepare a Claims Review Report as described in this Appendix for each Claims Review performed. The following information shall be included in the Claims Review Report for each Discovery Sample and Full Sample (if applicable).

  • Claims Review Findings a. Narrative Results.‌‌

  • Covered Claims Claim" means any claim, dispute or controversy between you and us that in any way arises from or relates to this Agreement, the Account, the issuance of any Card, any rewards program, any prior agreement or account. "Claim" includes disputes arising from actions or omissions prior to the date any Card was issued to you, including the advertising related to, application for or approval of the Account. "Claim" has the broadest possible meaning, and includes initial claims, counterclaims, cross-claims and third-party claims. It includes disputes based upon contract, tort, consumer rights, fraud and other intentional torts, constitution, statute, regulation, ordinance, common law and equity (including any claim for injunctive or declaratory relief). "Claim" does not include disputes about the validity, enforceability, coverage or scope of this Arbitration Provision or any part thereof (including, without limitation, the prohibition against class proceedings, private attorney general proceedings and/or multiple party proceedings described in Paragraph C.7 (the "Class Action Waiver"), the last sentence of Paragraph

  • Order Rejections 53.11.1 CenturyLink shall reject and return to CLEC any order that CenturyLink cannot provision, due to technical reasons, missing information, or jeopardy conditions resulting from CLEC ordering service at less than the standard order interval.

  • Product Warranty Claims When we receive a valid warranty claim for an HP hardware or software product, HP will either repair the relevant defect or replace the product. If HP is unable to complete the repair or replace the product within a reasonable time, Customer will be entitled to a full refund upon the prompt return of the product to HP (if hardware) or upon written confirmation by Customer that the relevant software product has been destroyed or permanently disabled. HP will pay for shipment of repaired or replaced products to Customer and Customer will be responsible for return shipment of the product to HP.

  • Claims Review Methodology a. C laims Review Population. A description of the Population subject to 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.

Time is Money Join Law Insider Premium to draft better contracts faster.