Claim Recovery Services. We will provide recovery services for Overpayments. We will reimburse you for, and you will not be responsible for recovery costs associated with, any Overpayments made by us due to our failure to act in accordance with the Standard of Care. You will be charged fees when any of the services described in this section are provided by us through a subcontractor except if we fail to meet our Standard of Care. The fees are deducted from the actual recoveries. You will be credited with the net amount of the recovery. We will provide you with a written notice of the basis of the fees for which you are charged; and, advance notice of any material changes in such fees or our recovery services. You delegate to us the discretion and authority to develop and use standards and procedures for any recovery under this section, including but not limited to, whether or not to seek recovery, what steps to take if we decide to seek recovery, and under what circumstances to compromise a claim or settle for less than the full amount of the claim. You recognize that use of these standards and procedures may not result in recovery or in full recovery for any particular case. We will not pursue any recovery if any applicable law does not permit it, or, if recovery would be impractical. We may choose to initiate litigation to recover payments, but we have no obligation to pursue litigation. If we initiate litigation, you will cooperate with us in the litigation. If this Agreement terminates, or, if our recovery services terminate, we can continue to recover any payments we are in the process of recovering. The appropriate fees will continue to be deducted from the actual recovery, when and if a recovery is obtained. You will not engage any entity except us to provide these recovery services without our prior approval. We agree that our recovery efforts or those of any and all subcontractors complies with all federal and state requirements for such activities.
Claim Recovery Services. We will provide recover services for Overpayments. We will reimburse You for, and You will not be responsible for recovery costs associated with, any Overpayments made by us due to Our gross negligence as determined by a court or other tribunal. We will provide services to recover HRA Plan benefits that were reimbursed and are recoverable by the HRA Plan because payment was or should not have been made pursuant to the terms of the HRA Plan. You delegate to us the discretion and authority to develop and use standards and procedures for any recovery under this section, including b not limited to, whether or not to seek recovery, what steps to take if We decide to seek recovery, and under what circumstances to compromise a claim or settle for less than the full amount of the claim.
Claim Recovery Services. All other provisions of Section 4.3 shall remain unchanged. Credit Balance Recovery. United utilizes on-site resources to perform hospital and/or facility audits to review, validate, and recover credit balances (dollars) existing on patient accounts to identify any recoverable amounts. Hospital Xxxx Audit. United utilizes on-site resources (registered/licensed nurses and/or certified coders) to perform in-depth reviews of hospital bills. Auditors will conduct line by line comparisons of itemized bills to the medical records to ensure billing accuracy and identify any recoverable amounts. Focused Claim Review. Board certified same-specialty physicians will audit claims and records of high-cost procedures. These reviews verify coding and billing accuracy before a claim is adjudicated. Claims for which billing and/or coding errors are identified will be adjusted before payment is issued.
Claim Recovery Services. United will provide recovery services for Overpayments, but United will not be responsible for recovery costs except as otherwise stated in this section. United will reimburse Customer for, and Customer will not be responsible for recovery costs associated with, any Overpayments made by United due to United’s failure to act in accordance with the Standard of Care. In some instances, United may be able to obtain Overpayment recoveries by applying (or offsetting) the Overpayment against future payments to the provider made by United. In effectuating Overpayment recoveries through offset, United will follow its established Overpayment recovery rules which include, among other things, the prioritization of Overpayment credits based on the age of the Overpayment in United’s system and funding type. In United’s application of Overpayment recovery through offset, timing differences may arise in the processing of claims payments, disbursement of provider checks, and the recovery of Overpayments. As a result, the Plan may in some instances receive the benefit of an Overpayment recovery before United actually receives the funds from the provider. Conversely, United may receive the funds before the Plan receives the credit for the Overpayment. It is hereby understood that the parties may retain any interest that accrues as a result of these timing differences. Details associated with Overpayment recoveries made through offset will be identified in the monthly reconciliation report provided to the designated representative for the Customer’s Plan. United will also provide services to recover Plan benefits that were paid and are recoverable by the Plan because payment was or should have been made by a third party for the same medical expense (other than in connection with coordination of benefits, Medicare, or other Overpayments). This is referred to as “Third Party Liability Recovery” (or “subrogation”). Customer will not engage any entity except United to provide the services described herein without United’s prior approval. Customer will be charged fees when any of the services described herein are provided by United through a subcontractor or affiliate except if United fails to meet the Standard of Care. The fees are deducted from the actual recoveries. Customer will be credited with the net amount of the recovery. Except as otherwise provided herein, and subject to the Customer's right to direct United to not pursue recovery, Customer delegates to United the discr...
