Claims Records Sample Clauses

Claims Records. Pharmacy BenefitDirect shall maintain, in the original form, or on electronic media, Claims received from Pharmacies and adequate records to verify payment to Pharmacies, and shall make information obtained from said claims and other records available to Client upon request. Exhibit X-x (By Reference) Pharmacy BenefitDirect Management Reports CLAIMS ITEMIZATION REPORT (biweekly) – prescription claims activity for each member during each two-week billing period. UNAUTHORIZED UTILIZATION REPORT (biweekly) – rejected claims and reason for rejection for each two-week billing period. CLAIMS SUMMARY REPORT (monthly) – cardholder claims activity for the current report period providing breakdown by cardholder, spouse, dependents and total. PROVIDER UTILIZATION REPORT (quarterly) – drug utilization and related cost data for the previous three-month cycle sorted by therapeutic class. CLAIMS COST ANALYSIS (monthly) – the single most important report in the system providing detailed cost and utilization data to assist in fiscal management. It provides monthly comparisons of relational data and rolling averages for a six-month time period. REJECTED CLAIMS REPORT (monthly) – rejected claims activity — reasons for, how many and how much – for the current report period. INCURRED CLAIMS REPORT (monthly) – monthly record of history and current claims activity that, by extrapolation of data, can provide for projection of incurred liabilities. GENERIC UTILIZATION REPORT (monthly) – a cumulative record, by month and year, of generic utilization showing extent of generic substitution, cost savings, and unrealized potential. PHYSICIAN UTILIZATION REPORT (monthly) – physician activity for the current report period detailing number of prescriptions, total cost, average prescription cost, and generic prescribing data. MANUFACTURER REBATE REPORT (quarterly, on demand) – summary of drug purchases for the previous quarter, by therapeutic class and manufacturer, to be used in claiming manufacturer rebates. CARDHOLDER UTILIZATION REVIEW (monthly, on demand) – part of a three-part series to aid in identifying potential cardholder abuse. This report details circumstances of purchases that tend to be indicative of abuse – multiple pharmacies, multiple physicians, excessive use of drugs of abuse, etc. CARDHOLDER UTILIZATION SUMMARY (monthly, on demand) – the second report in the cardholder abuse series. Through the use of weighted point scales, this report analyzes the information from the ...
Sample 1
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Claims Records. When this Agreement terminates, Plan Supervisor shall provide to Plan or its designee a historical accounting of claims payments. At the option of Plan Supervisor, all records of the Plan shall be returned to the Employer upon termination of this Agreement. Employer shall reimburse the Plan Supervisor for the cost of retrieving Plan records from storage, if applicable, and shipping Plan records to the Employer. The delivery of records maintained on hard copy files, microfilm or magnetic tape, at Plan Supervisor’s option, shall be deemed to be in compliance with this Section. In the event records are stored on microfilm and a retrieval fee is charged to Plan Supervisor, Employer shall pay such fee. In the event records are stored on magnetic tape, an explanation of record format shall be provided. At the time the transfer of records occurs, Plan Supervisor shall be relieved of further responsibility for performing any of the services enumerated in this Agreement.
Sample 1
Claims Records. When this Agreement terminates, PNC shall provide to Plan or its designee a historical accounting of Benefits. At the option of PNC, all records of the Plan shall be returned to the Employer upon termination of this Agreement. Employer shall reimburse the PNC for the cost of retrieving Plan records from storage, if applicable, and shipping Plan records to the Employer. The delivery of records maintained on hard copy files, microfilm or magnetic tape, at PNC's option, shall be deemed to be in compliance with this Section. In the event records are stored on microfilm and a retrieval fee is charged to PNC, Employer shall pay such fee. In the event records are stored on magnetic tape, an explanation of record format shall be provided. At the time the transfer of records occurs, PNC shall be relieved of further responsibility for performing any of the services enumerated in this Agreement.
Sample 1

Related to Claims Records

  • Accounts; Records The Servicer shall maintain accounts and records as to the Recovery Property accurately and in accordance with its standard accounting procedures and in sufficient detail (i) to permit reconciliation between payments or recoveries with respect to the Recovery Property and the amounts from time to time remitted to the Collection Account in respect of the Recovery Property and (ii) to permit the FRC Collections held by the Servicer to be accounted for separately from the funds with which they may be commingled, so that the dollar amounts of FRC Collections commingled with the Servicer’s funds may be properly identified and traced.

  • Account Records Permanent Mortgage Loan account records must be maintained by the Servicer for each Mortgage Loan. Each account record must be identifiable by the Servicer Loan Number.

  • Claims Released Subject only to the exceptions just noted, I am releasing all known and unknown claims, promises, causes of action, or similar rights of any type that I may have (Claims) with respect to any Released Party listed in Section 2(d). I understand that the Claims I am releasing might arise under many different laws (including statutes, regulations, other administrative guidance, and common law doctrines), such as the following: Anti-discrimination statutes, such as the Age Discrimination in ---------------------------- Employment Act and Executive Order 11,141, which prohibit age discrimination in employment; Title VII of the Civil Rights Act of 1964, Sections 1981 and 1983 of the Civil Rights Act of 1866, and Executive Order 11,246, which prohibit discrimination based on race, color, national origin, religion, or sex; the Equal Pay Act, which prohibits paying men and women unequal pay for equal work; the Americans With Disabilities Act and Sections 503 and 504 of the Rehabilitation Act of 1973, which prohibit discrimination based on disability; and any other federal, state, or local laws prohibiting employment discrimination, such as the California Fair Employment and Housing Act, which prohibits discrimination in employment based on race, color, national origin, ancestry, physical or mental disability, medical condition, marital status, sex, or age. Federal employment statutes, such as the WARN Act, which requires that --------------------------- advance notice be given of certain work force reductions; the Employee Retirement Income Security Act of 1974, which, among other things, protects employee benefits; the Fair Labor Standards Act of 1938, which regulates wage and hour matters; the Family and Medical Leave Act of 1993, which requires employers to provide leaves of absence under certain circumstances; and any other federal laws relating to employment, such as veterans' reemployment rights laws. Other laws, such as any federal, state, or local laws providing ---------- workers' compensation benefits, restricting an employer's right to terminate employees, or otherwise regulating employment; any federal, state, or local law enforcing express or implied employment contracts or requiring an employer to deal with employees fairly or in good faith; any other federal, state, or local laws providing recourse for alleged wrongful discharge, tort, physical or personal injury, emotional distress, fraud, negligent misrepresentation, defamation, and similar or related claims, such as California Labor Code Section 200 et seq., relating to salary, commission, compensation, benefits, and other matters; the California Workers' Compensation Act; or any applicable California Industrial Welfare Commission order.

  • Documents, Records and Funds in Possession of the Servicer to be Held for the Trustee......................... Section 3.17

  • Books Records Accounting and Reports Section 8.1 Records and Accounting 74 Section 8.2 Fiscal Year 74 Section 8.3 Reports 74 ARTICLE IX

  • Business Records Keep, and cause each Subsidiary to keep, adequate records and books of account with respect to its business activities in which proper entries are made in accordance with GAAP reflecting all its financial transactions.

  • Patient Records Upon termination of this Agreement, the New PC shall retain all patient dental records maintained by the New PC or the MSO in the name of the New PC. During the term of this Agreement, and thereafter, the New PC or its designee shall have reasonable access during normal business hours to the New PC's and the MSO's records, including, but not limited to, records of collections, expenses and disbursements as kept by the MSO in performing the MSO's obligations under this Agreement, and the New PC may copy any or all such records.

  • Files and Records A. An employee will have the right to review the contents of files concerning the employee, excluding initial references of the district pertaining to said employee or other items statutorily exempt from disclosure originating after initial employment, and to have a representative of the Association accompany him/her in such a review.

  • Access to Accounting Records All books and records of the Company shall be maintained at any office of the Company or at the Company’s principal place of business, and the Member, and its duly authorized representative, shall have access to them at such office of the Company and the right to inspect and copy them at reasonable times.

  • Books Records and Reports 6 19. The Contractor shall establish and maintain accounts and other books and records 7 pertaining to administration of the terms and conditions of this Settlement Contract, including: 8 the Contractor's financial transactions, water supply data, and Project land and right-of-way 9 agreements; the water users' land-use (crop census), land ownership, land-leasing and water use 10 data; and other matters that the Contracting Officer may require. Reports thereon shall be 11 furnished to the Contracting Officer in such form and on such date or dates as the Contracting 12 Officer may require. Subject to applicable Federal laws and regulations, each party to this 13 Settlement Contract shall have the right during office hours to examine and make copies of each 14 other’s books and official records relating to matters covered by this Settlement Contract.

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