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.
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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.
Sample 1

Examples of Claim audit in a sentence

  • 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.

  • If any Claim, audit, or litigation arising out of, in connection with, or related to this Contract is initiated, all documents and records shall be resolved or completed, whichever occurs later.

  • 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 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 is resolved or completed, whichever occurs later.

  • 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.

  • CONTRACTOR’s FWA retrospective Claim audit will focus on 37 known and suspected areas of aberrant behavior, using MEDIC reported targets, areas of high incidence 1 of fraud and other potential areas of FWA, data mining, and other reports.

  • Environmental Incident (EPR 100.02-6.1.1): Any spill that has caused, or may potentially cause, significant harm to the environment including a petroleum spill of >70 litres, any petroleum spill that did or had the potential of entering a water body or protected public water supply area or sewer, hazardous material spills regardless of volume, PCB spills in storage of 2ppm or more regardless of volume, oil spills of 50ppm PCB or more, or PCB spills of >1gram.

  • Clinical-UM Closed • Claim audit successful.Analysis: During Quarter 1, there were 13 projects in progress (including 2 PIPs).

  • Buyer shall, and shall cause its Affiliates, and the Sellers and Sellers’ Representative shall, and shall cause each of their 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.

Related to Claim audit

  • Claim Determination Period means a calendar year. However, it does not include any part of a year during which a person has no coverage under This Plan, or any part of a year before the date this COB provision or a similar provision takes effect.

  • Tax Audit means any audit, assessment, or other examination relating to Taxes by any Tax Authority or any judicial or administrative proceedings relating to Taxes.

  • Claim Period means the period of time during which a Settlement Class Member must submit a Claim Form to be eligible to receive a Cash Benefit or Billing Credit Option as part of the Settlement. The Claim Period shall commence not later than thirty (30) days after the Preliminary Approval Date, as defined herein, and shall conclude not more than ninety (90) days after it commences.

  • Claim Expenses means reasonable documented attorneys’ fees and all other reasonable documented out-of-pocket costs, expenses and obligations (including experts’ fees, travel expenses, court costs, retainers, transcript fees, duplicating, printing and binding costs, as well as telecommunications, postage and courier charges) paid or incurred in connection with investigating, defending, being a witness in or participating in (including on appeal), or preparing to investigate, defend, be a witness in or participate in, any Claim, including any Action relating to a claim for indemnification or advancement brought by an Indemnified Party as contemplated in Section 7.5.

  • Audit means the examination of a person or the inspection of the books, records, memoranda, or accounts of a person, ordered to appear before the Tax Administrator, for the purpose of determining liability for a municipal income tax.

  • Claim Amount means the amount calculated in accordance with Section 6.2 of this Policy.

  • Unresolved Claim means a Claim, which at the relevant time, in whole or in part: (a) has not been Finally Determined to be a Proven Claim in accordance with the Amended Claims Procedure Order and this Plan; (b) is validly disputed in accordance with the Amended Claims Procedure Order; and/or (c) remains subject to review and for which a Notice of Allowance or Notice of Revision or Disallowance (each as defined in the Amended Claims Procedure Order) has not been issued to the Creditor in accordance with the Amended Claims Procedure Order as at the date of this Plan, in each of the foregoing clauses, including both as to proof and/or quantum;

  • Acoustic Assessment Report means the report, prepared in accordance with Publication NPC-233 and Appendix A of the Basic Comprehensive User Guide,by HGC Engineering and dated August 22, 2008 submitted in support of the application, that documents all sources of noise emissions and Noise Control Measures present at the Facility and includes all up-dated Acoustic Assessment Reports as required by the Documentation Requirements conditions of this Certificate to demonstrate continued compliance with the Performance Limits following the implementation of any Modification.

  • Indemnity Claim has the meaning set forth in Section 8.3.

  • conformity assessment body means a body that performs conformity assessment activities including calibration, testing, certification and inspection;

  • Closing Date Statement has the meaning set forth in Section 2.06(b).

  • Single Audit means an audit that includes an examination of an organization's financial statements, internal controls, and compliance with the requirements of Federal or State awards.

  • Phase I assessment as described in, and meeting the criteria of, (i) Chapter 5 of the FNMA Multifamily Guide or any successor provisions covering the same subject matter in the case of a Specially Serviced Mortgage Loan as to which the related Mortgaged Property is multifamily property or (ii) the American Society for Testing and Materials in the case of Specially Serviced Mortgage Loan as to which the related Mortgaged Property is not multifamily property.

  • Root Cause Analysis Report means a report addressing a problem or non-conformance, in order to get to the ‘root cause’ of the problem, which thereby assists in correcting or eliminating the cause, and prevent the problem from recurring.

  • Adverse Benefit Determination means any of the following:

  • Environmental Impact Assessment means a systematic examination conducted to determine whether or not a programme, activity or project will have any adverse impacts on the environment;

  • Environmental Defect Notice shall have the meaning set forth in Section 12.1(a).

  • Claim Notice has the meaning set forth in Section 8.4(a).

  • Title Defect Notice shall have the meaning set forth in Section 11.2(a).

  • Unresolved Claims has the meaning set forth in Section 7.6(c).

  • Defect Notice shall have the meaning specified in Section 3.2 of this Agreement.

  • Impact Assessment has the meaning given to it in Clause 22.1.3 (Variation Procedure);

  • Remediation Costs means the cost of any action taken to reduce the concentration of contaminants on, in or under the Eligible Property to permit a record of site condition to be filed in the Environmental Site Registry under section 168.4 of the Environmental Protection Act and the cost of complying with any certificate of property use issued under section 168.6 of the Environmental Protection Act, as further specified in the CIP.

  • Dispute Period shall have the meaning specified in Section 9.3(a).

  • Expected Claim Notice means a notice that, as a result of a legal proceeding instituted by or written claim made by a third party, an Indemnified Party reasonably expects to incur Damages for which it is entitled to indemnification under Article VII.

  • Practical examination means a demonstration through application of the safety rules and principles in industrial radiography including use of all procedures and equipment to be used by radiographic personnel.