Claim audit definition

Claim audit means a process to determine whether data in a claimant’s medical record for health care documents health care services listed on a claim for payment submitted to a carrier. Claim audit does not mean a review of the medical necessity of the services provided, or the reasonableness of charges for the services.
View Source
Claim audit means a process to determine whether data in a claimant’s medical record documents healthcare services listed on a claim for payment submitted to a health insurance organization or insurer. Claim audit does not mean a review of the medical necessity of the services provided, or the reasonableness of charges for the services.
View Source

Examples of Claim audit in a sentence

  • The Claims Administrator — or his or her delegate — shall have the power to hire and shall hire and appoint such staff and other appropriate agents, including the Quality Control Supervisor and/or any persons or entities performing Claim audit functions under this Settlement Facility Agreement, as necessary to carry out the functions of the Claims Administrator under this Settlement Facility Agreement.

  • There is no threatened, potential, contemplated, pending, or existing adverse Litigation, Claim, audit or governmental investigation involving Seller, Shareholder, any Client or any of the Assets which has not been disclosed to Buyer.

  • There is no Claim, audit, other examination, matter in controversy, proposed adjustment, refund litigation or other Proceeding pending against, or with respect to, any Company with regard to Taxes.

  • For a period of not less than six years after the date of Final Acceptance of the Contract (“Preservation Period”); or if any Claim, audit or litigation arising out of, in connection with, or related to this Contract is initiated, all documents shall be retained until such Claim, audit or litigation involving the records is resolved or completed, whichever occurs later.

  • There is no litigation, action, lawsuit, Claim, audit, review, examination, inquiry, proceeding or investigation involving Buyer pending or, to Buyer's knowledge, threatened which questions the legality or propriety of the transactions contemplated by this Agreement or any of the Transaction Documents to be entered into by Buyer.

  • CONTRACTOR’s FWA retrospective Claim audit will focus on 2 known and suspected areas of aberrant behavior, using MEDIC reported targets, areas of high incidence 3 of fraud and other potential areas of FWA, data mining, and other reports.

  • There is no litigation, action, lawsuit, Claim, audit, review, examination, inquiry, proceeding or investigation involving Buyer pending or, to Buyer's knowledge, threatened which questions the legality or propriety of the transactions contemplated by this Agreement or any of the Transaction Documents.

  • Contractor’s FWA retrospective Claim audit will focus on known and suspected areas of aberrant behavior, using MEDIC reported targets, areas of high incidence of fraud and other potential areas of FWA, data mining, and other reports.

  • For a period of not less than six (6) years after the date of Final Acceptance of the Contract (“Preservation Period”); or if any Claim, audit, or litigation arising out of, in connection with, or related to this Contract is initiated, all documents shall be retained until such Claim, audit or litigation involving the documents is resolved or completed, whichever occurs later.

  • Buyers shall, and shall cause their respective Affiliates, and Seller shall, and shall cause its Affiliates, to cooperate fully, as and to the extent reasonably requested by the other Party or its applicable Affiliate, in connection with the preparation and filing of any Tax Return, and any Legal Proceeding, Tax Claim, audit or examination with respect to Taxes.