Quarterly Claims Sample Sample Clauses

Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims from the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.‌
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Quarterly Claims Sample. Within 15 days following the end of each three-month period during the term of this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of MBPC during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. MBPC shall provide the IRO with a list of all MBPC’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Population that will be subject to review by the IRO. The randomly selected 30 Paid Claims will be reviewed by the IRO based on the supporting documentation available at MBPC’s office or under MBPC’s control and applicable billing and coding regulations and guidance to determine whether each claim was correctly coded, submitted, and reimbursed. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims Review Report). The Quarterly Claims Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims Review.
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Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Alaska Neurology during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
Sample 1
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf ofNorthwest ENT during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG' s Office of Audit Services' Statistical Sampling Software, also known as RAT-‌ STATS, which is currently available at xxxxx://xx x.xxx.xxx/xxxxxxxxxx/xxx-xxxxx/xxxxx.xxx. Northwest ENT IA Appenaix 8
Sample 1
Quarterly Claims Sample. Within 15 days following the end of each three-month period during the term of this IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp. Xxxxx shall provide the IRO with a list of all Xxxxx’s Paid Claims for the three-month period covered by the Quarterly Claims Sample. The IRO should number each Paid Claim in the Population sequentially prior to generating the random numbers used to select the Quarterly Claims Sample. The IRO should generate 30 random numbers using RAT-STATS and then use the random numbers to identify the 30 Paid Claims in the Population that will be subject to review by the IRO. The IRO shall review the randomly selected 30 Paid Claims for (1) correct coding, submission, and reimbursement, and (2) medical necessity, appropriateness of case selection, quality of procedure, execution, proper response to intraprocedural problems, accurate assessment of procedure outcome, and appropriateness of procedure management. The Paid Claims shall be reviewed based on the supporting documentation available from Anand or under Xxxxx’s control and applicable regulations and guidance, including but not limited to applicable billing and coding regulations and guidance and the established practice guidelines and generally accepted standards practice described by the American College of Cardiology, to determine (1) whether each claim was correctly coded, submitted, and reimbursed, and (2) whether each procedure was medically necessary and appropriate. The IRO shall prepare a written report of its findings from the Quarterly Claims Sample, as described in Section C below (Quarterly Claims and Cardiac Procedures Review Report). The Quarterly Claims and Cardiac Procedures Review Report shall be submitted to the OIG within 60 days following the end of the three-month period covered by each Quarterly Claims and Cardiac Procedures Review.
Sample 1
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xxxxx Pharmacy during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG's Office of Audit Services' Statistical Sampling Software, also known as RAT- STATS, which is currently available at xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.‌‌ Xxxxxx Xxxxx Professional Pharmacy, Inc. dlbla Xxxxx Pharmacy, Gwy Xxxx, and Xxxxxx X. Xxxxxxx Integrity Agreement- Appendix B
Sample 1
Quarterly Claims Sample a. Within 15 days following the end of each three-month period during the term of the IA, the IRO shall randomly select a sample of 30 Paid Claims submitted by or on behalf of Xxxxxx during the preceding three-month period (Quarterly Claims Sample). The sample must be selected through the use of OIG’s Office of Audit Services’ Statistical Sampling Software, also known as RAT-‌ 1 The overpayment definition and paid claim definition should be expanded to include other Federal health care programs if claims to those payors were at issue in the underlying case or represent a significant portion of the Practitioner’s payor mix.‌ STATS, which is currently available at‌‌‌ xxxxx://xxx.xxx.xxx/compliance/rat-stats/index.asp.
Sample 1
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Related to Quarterly Claims Sample

  • Quarterly Contractor Performance Reporting Customers shall complete a Contractor Performance Survey (Exhibit I) for each Contractor on a Quarterly basis. Customers will electronically submit the completed Contractor Performance Survey(s) to the Department Contract Manager no later than the due date indicated in Contract Exhibit D, Section 17, Additional Special Contract Conditions. The completed Contractor Performance Survey(s) will be used by the Department as a performance-reporting tool to measure the performance of Contractors. The Department reserves the right to modify the Contractor Performance Survey document and introduce additional performance-reporting tools as they are developed, including online tools (e.g. tools within MyFloridaMarketPlace or on the Department's website).

  • Contract Quarterly Sales Reports The Contractor shall submit complete Quarterly Sales Reports to the Department’s Contract Manager within 30 calendar days after the close of each State fiscal quarter (the State’s fiscal quarters close on September 30, December 31, March 31, and June 30). Reports must be submitted in MS Excel using the DMS Quarterly Sales Report Format, which can be accessed at xxxxx://xxx.xxx.xxxxxxxxx.xxx/business_operations/ state_purchasing/vendor_resources/quarterly_sales_report_format. Initiation and submission of the most recent version of the Quarterly Sales Report posted on the DMS website is the responsibility of the Contractor without prompting or notification from the Department’s Contract Manager. If no orders are received during the quarter, the Contractor must email the DMS Contract Manager confirming there was no activity.

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

  • Quarterly Sales Reports The Contractor shall submit a completed Quarterly Sales Report electronically, in the required format, to the Department’s Contract Manager within thirty (30) calendar days after close of each quarter. The quarterly sales report can be found here: xxxxx://xxx.xxx.xxxxxxxxx.xxx/business_operations/ state_purchasing/vendor_resources/quarterly_sales_report_format. The Contract Quarterly Sales Report will include all sales and orders associated with this Contract from Customers received during the reporting period. Initiation and submission of the Sales Report is the responsibility of the Contractor without prompting or notification from the DMS Contract Manager. Failure to provide the quarterly sales report will result in the imposition of financial consequences and may result in the Contractor being found in default and the termination of the Contract. Initiation and submission of the quarterly sales report are the responsibility of the Contractor without prompting or notification by the Department. Sales will be reviewed on a quarterly basis. If no sales are recorded during the period, the Contractor must submit a report stating that there was no activity. If no sales are recorded in two consecutive quarters, the Contractor may be placed in probationary status or the Department may terminate the Contract. Quarter 1 – (July-September) – due 30 calendar days after the close of the period Quarter 2 – (October-December) – due 30 calendar days after the close of the period Quarter 3 – (January-March) – due 30 calendar days after the close of the period Quarter 4 – (April-June) due 30 calendar days after the close of the period Exceptions may be made if a delay in submitting reports is attributable to circumstances that are clearly beyond the control of the Contractor. The burden of proof of unavoidable delay shall rest with the Contractor and shall be supplied in a written form and submitted to the Department. The Department reserves the right to request additional sales information as needed.

  • 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).

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