OF THE MATCHING PROGRAM Clause Samples
The "OF THE MATCHING PROGRAM" clause defines the rules and procedures governing a matching program, typically used to pair participants, offers, or requests according to predetermined criteria. In practice, this clause outlines how matches are identified, the eligibility requirements for participation, and the process by which matches are confirmed or rejected. Its core function is to ensure a transparent and fair system for matching, thereby reducing disputes and clarifying expectations for all parties involved.
OF THE MATCHING PROGRAM. The purpose of this agreement is to establish the conditions, safeguards, and procedures under which the Centers for Medicare & Medicaid Services (CMS) will conduct a computer matching program with the State of New Jersey, Department of Human Services (NJDHS), Division of Medical Assistance and Health Services (DMAHS) to study claims, billing, and eligibility information to detect suspected instances of Medicare and Medicaid fraud and abuse (F&A) in the State of New Jersey. CMS and NJDHS will provide Electronic Data Systems Corporation, a CMS contractor (hereinafter referred to as the ‘‘Custodian’’), with Medicare and Medicaid records pertaining to eligibility, claims, and billing which the Custodian will match in order to merge the information into a single database. Utilizing fraud detection software, the information will then be used to identify patterns of aberrant practices requiring further investigation. The following are examples of the type of aberrant practices that may constitute F&A by practitioners, providers, and suppliers in the State of New Jersey expected to be identified in this matching program: (1) Billing for provisions of more than 24 hours of services in one day, (2) providing treatment and services in ways more statistically significant than similar practitioner groups, and (3) up-coding and billing for services more expensive than those actually performed.
OF THE MATCHING PROGRAM. The purpose of the Computer Matching Agreement is to establish the terms, conditions, safeguards, and procedures under which the Peace Corps will provide records, information, or data to CMS for verifying eligibility for Minimum Essential Coverage through a PC Health Benefits Plan. The data will be used by CMS in its capacity as a Federally-facilitated Exchange, and agencies administering insurance affordability programs that will receive the results of verifications using PC data obtained through the CMS Data Services Hub. Data will be matched for the purpose of verifying an Applicant or Enrollee’s eligibility for PC Health Benefit Plans that constitute minimum essential coverage as defined in section 5000A(f) of the Internal Revenue ▇▇▇▇ ▇▇ ▇▇▇▇, ▇▇ ▇.▇.▇. §▇▇▇▇▇, as amended by §1501 of the ACA.
OF THE MATCHING PROGRAM. The purpose of the Computer Matching Agreement is to establish the terms, conditions, safeguards, and procedures under which DoD will provide records, information, or data to CMS for making eligibility determinations for advance payments of the premium tax credit (APTC) and cost sharing reductions (CSR). The data will be used by CMS in its capacity as a Federally-facilitated Exchange, and by State-based Exchanges that will receive the results of verifications using OPM data obtained through the CMS Data Services Hub. Data will be matched for the purpose of assisting CMS or a State-based Exchange to determine eligibility for the following benefits: (1) APTC under 26 U.S.C. § 36B and (2) CSR under Section 1402 of the ACA. Specifically, CMS will use OPM data to verify an Applicant or Enrollee’s eligibility for OPM health care programs that constitute minimum essential coverage as defined in section 5000A(f) of the Internal Revenue Code of 1986, 26 U.S.C. §5000A, as amended by §1501 of the ACA.
OF THE MATCHING PROGRAM. The purpose of the Computer Matching Agreement is to establish the terms, conditions, safeguards, and procedures under which OPM will provide records, information, or data to CMS for verifying eligibility for Minimum Essential Coverage through an OPM Health Benefits Plan. The data will be used by CMS in its capacity as a Federally-facilitated Exchange, and agencies administering insurance affordability programs that will receive the results of verifications using OPM data obtained through the CMS Data Services Hub. Data will be matched for the purpose of verifying an Applicant or Enrollee’s eligibility for OPM Health Benefit Plans that constitute minimum essential coverage as defined in section 5000A(f) of the Internal Revenue Code of 1986, 26 U.S.C. §5000A, as amended by §1501 of the ACA.
OF THE MATCHING PROGRAM. The purpose of the Computer Matching Agreement is to establish the terms, conditions, safeguards, and procedures under which CMS will disclose certain information to State-based Administering Entities in accordance with the Patient Protection and Affordable Care Act of 2010 (Public Law 111-148), as amended by the Health Care and Education Reconciliation Act (Public Law 111-152), which are referred to collectively as the Affordable Care Act (ACA), amendments to the Social Security Act made by the ACA, and the implementing regulations. The Administering Entities will use the data, accessed through the Hub, to make Eligibility Determinations for enrollment in an applicable State health subsidy program. This Computer Matching Agreement also establishes the terms, conditions, safeguards, and procedures under which State Medicaid/CHIP agencies shall provide data to CMS (as the Federally-facilitated Marketplace (FFM)), State-based Marketplaces (SBMs) and BHPs to verify whether an Applicant or Enrollee who has submitted an application to the FFM or an SBM has current eligibility or enrollment in a Medicaid/CHIP program.