Common use of Validation Review Clause in Contracts

Validation Review. In the event OIG has reason to believe that: (a) the Claims Review fails to conform to the requirements of this CIA; or (b) the IRO’s findings or Claims Review results are inaccurate, OIG may, at its sole discretion, conduct its own review to determine whether the Claims Review complied with the requirements of the CIA and/or the findings or Claims Review results are inaccurate (Validation Review). CCH shall pay for the reasonable cost of any such review performed by OIG or any of its designated agents. Any Validation Review of Reports submitted as part of CCH’s final Annual Report shall be initiated no later than one year after CCH’s final submission (as described in Section II) is received by OIG. Prior to initiating a Validation Review, OIG shall notify CCH of its intent to do so and provide a written explanation of why OIG believes such a review is necessary. To resolve any concerns raised by OIG, CCH may request a meeting with OIG to: (a) discuss the results of any Claims Review submissions or findings; (b) present any additional information to clarify the results of the Claims Review or to correct the inaccuracy of the Claims Review; and/or (c) propose alternatives to the proposed Validation Review. CCH agrees to provide any additional information as may be requested by OIG under this Section III.D.3 in an expedited manner. OIG will attempt in good faith to resolve any Claims Review issues with CCH prior to conducting a Validation Review. However, the final determination as to whether or not to proceed with a Validation Review shall be made at the sole discretion of OIG.

Validation Review. In the event OIG has reason to believe that: (a) any of the Claims Review IRO Reviews fails to conform to the requirements of this CIA; or (b) the IRO’s findings or Claims Review results are inaccurate, OIG may, at its sole discretion, conduct its own review to determine whether the Claims applicable IRO Review complied with the requirements of the CIA and/or the findings or Claims Review results are inaccurate (Validation Review). CCH J&J shall pay for the reasonable cost of any such review performed by OIG or any of its designated agents. Any Validation Review of Reports reports submitted as part of CCHJ&J’s final Annual Report shall be initiated no later than one year after CCHJ&J’s final submission (as described in Section IIII.B) is received by OIG. Prior to initiating a Validation Review, OIG shall notify CCH J&J of its intent to do so and provide a written explanation of why OIG believes such a review is necessary. To resolve any concerns raised by OIG, CCH J&J may request a meeting with OIG to: (a) discuss the results of any Claims IRO Review submissions or findings; (b) present any additional information to clarify the results of the Claims IRO Review or to correct the inaccuracy of the Claims IRO Review; and/or (c) propose alternatives to the proposed Validation Review. CCH J&J agrees to provide any additional information as may be requested by OIG under this Section III.D.3 III.E.3 in an expedited manner. OIG will attempt in good faith to resolve any Claims IRO Review issues with CCH J&J prior to conducting a Validation Review. However, the final determination as to whether or not to proceed with a Validation Review shall be made at the sole discretion of OIG.