Utilization Data. The contractor shall conduct a quarterly analysis of utilization data, including inpatient utilization, and shall follow-up on cases of potential under- and over-utilization. Over- and under-utilization shall be determined based on comparison to established medical community standards. See Section A.7.7 of the Appendices (Table 5) for a description of utilization data to be submitted to the Department.
Utilization Data. DMAP will maintain Medicaid Utilization Information applicable to the Covered Product(s) for use in calculating the State Supplemental Rebate. DMAP will provide aggregate Medicaid Utilization Information applicable to Covered Product(s) to Manufacturer on a Quarterly basis in connection with the invoicing required under paragraph 3.E.
Utilization Data. Physician Group shall, upon request, provide Health Plan with information on the utilization and cost of Capitated Services provided to Enrollees in such detail as to allow Health Plan to conduct analysis of costs as required by HCFA, as dictated by sound business practices and for the conduct of quality assurance and utilization review activities by Plan. Such information to be provided by Physician Group will not include information beyond that customarily provided on a claim form such as Form HCFA-1500 and shall be provided in the form of a paper report, computer disc or computer tape as agreed by the parties. Required data will be delivered by Physician Group to Health Plan not later than forty-five (45) days following written request by Health Plan.
Utilization Data. Contractor agrees to provide, for each member, person level records that describe the care received by that individual during his or her enrollment period with the Contractor, such as records shall be provided at intervals specified by EOHHS. Currently the State requests these data files be sent at the completion of each of the Contractor’s financial cycles. In addition, Contractor agrees to provide aggregate utilization data for all members at such intervals as required by the State.
Utilization Data. The Customer acknowledges and agrees that to the extent permitted by law, the aggregated data derived from telemetric information and data related to how Users access and use the Software (including, but not limited to, stack trace data and reports related thereto) are owned by Sharegate and do not constitute Customer Data.
Utilization Data. Medical Group must submit to PacifiCare utilization data pertaining to all Covered Services provided or arranged by Medical Group and Participating Providers to Members as described in this Agreement and the Provider Manual. Such utilization data includes all Member-specific encounter data reasonably required by PacifiCare to conduct utilization review and to comply with all reporting requirements of Governmental Agencies.
Utilization Data. SlamData will have the right to collect, extract, compile synthesize, and analyze data or information resulting from Your utilization of the SlamData Software. To the extent collected by SlamData, such data will be solely owned by SlamData and may be used by SlamData for any lawful business purpose without a duty of accounting to You or any third party, provided that such data is used only in an aggregated form without specifically identifying You as the source of the data.
Utilization Data. As indicated earlier, Medicare utilization is an important data source used in determining the practice expense RVUs. In our final rule published on November 2, 1998 (63 FR 58815), we used 1997 Medicare utilization data to create the original resource-based practice expense RVUs. Based on a public comment, we indicated in our November 2, 1999 final rule (64 FR 59405) that we would use 1998 Medicare utilization to develop the fully implemented RVUs that appear in that final rule. Because these data were unavailable to us for the proposed rule, the first time we could act on this public comment was in the final rule. We have continued our policy of using the latest utilization data to develop each successive year’s fully implemented practice expense RVUs during each year of the transition (see 65 FR 65436, published on November 1, 2000, and 66 FR 55322, published on November 1, 2001). While substituting the latest year’s utilization data into the practice expense methodology generally made little difference on total Medicare payments per specialty, it had a larger impact on services that have values affected by the zero physician work pool. The practice expense values for the technical component and other services included in the zero physician work pool declined 4 percent in 2002 as a result of using the most recent Medicare utilization data. Since the technical component is used to derive the global practice expense RVUs for professional and technical component services, there was also a reduction in the practice expense RVU for the global service. The specialties that provide many of the services that are included in the zero physician work pool have expressed concern about the impact of the most recent data on utilization on values for their services. They recently suggested that we use combined utilization data from 1997 to 2000 to determine the practice expense values. Alternatively, these commenters suggested using either the 1997 or 1999 utilization as a ‘‘base year’’ until an alternative to the zero physician work pool can be developed. These commenters further indicated that, once an option is chosen, we should not use more recent utilization data until comprehensive reform of the zero physician work methodology is adopted. We believe the suggestion of using multiple years of utilization data in the practice expense methodology has merit. Using multiple years of data has the potential to minimize the effect of year to year case mix changes on pract...