Common use of Claims Review Sample Clause in Contracts

Claims Review Sample. Prior to the end of each Reporting Period, CHN shall furnish to the IRO a list that identifies the top five CHN hospitals based upon amounts received for Paid Claims together with the amounts received for Paid Claims by each of these CHN hospitals during the Reporting Period. The IRO shall randomly select two of these hospitals (each a Selected CHN Hospital). For each of the Selected CHN Hospitals, the IRO shall select a random sample of 100 Paid Claims (each a Claims Review Sample). The IRO shall review the Paid Claims based on CHN’s documentation and the applicable Medicare program requirements to determine whether the items and services furnished were medically necessary and appropriately documented, and whether the claim was correctly coded, submitted, and reimbursed.