Common use of Source of Data Clause in Contracts

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Quarterly Claims Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary contractor manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Eligibility Review and the Appropriate Level of Services Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, ; physician orders, ; certificates of medical necessity, ; requisition forms, ; local medical review policies (including title and policy number), ; CMS program memoranda (including title and issuance number), ; Medicare carrier or intermediary manual or bulletins (including issue and date), ; other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Inpatient Medical Necessity and Appropriateness Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the Billing IRO when performing the Claims Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Additional Items Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Inpatient Medical Necessity and Appropriateness Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives)) and any screening criteria used for level of care determinations such as InterQual or Milliman.

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins New York State issued regulatory guidance (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, treatment plans, care plans, behavioral intervention plans, individualized education programs, physician orders, certificates of medical necessitypsychotherapy notes or narratives, requisition formspsychological examination report or notes, local medical review policies (including title and policy number)Medicaid managed care organization contract terms, CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue issue, version, and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Additional Items Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier carrier, State Medicaid agency or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).directives).‌‌‌‌

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Eligibility Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician ordersorders (including drug prescriptions), certificates of medical necessity, requisition forms, health plan authorizations respecting drugs that require pre-dispensing authorization, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or Corporate Integrity Agreement HealthSouth Corporation bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).directives).‌‌‌

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician ordersorders (including drug prescriptions), certificates of medical necessity, requisition forms, health plan authorizations respecting drugs that require pre- dispensing authorization, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician orders, certificates of medical necessity, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).

Source of Data. A description of the specific documentation relied upon by the IRO when performing the Claims Review (e.g., medical records, physician orders, certificates of medical necessity, OASIS data, requisition forms, local medical review policies (including title and policy number), CMS program memoranda (including title and issuance number), Medicare carrier or intermediary manual or bulletins (including issue and date), other policies, regulations, or directives).