Common use of Cost Avoidance and Recovery Clause in Contracts

Cost Avoidance and Recovery. 5.1.13.3.1.1. The Contractor shall recover or cost avoid claims where an Enrollee has been involved in an accident or lawsuit in accordance with Appendix N. Claims Editing and Reporting The Contractor shall utilize the following claims editing and reporting procedures to identify potential accident and/or other third party liability cases: Claims Reporting – Specific diagnosis ranges that may indicate potential accident and casualty cases; Provider Notification – Claims where providers have noted accident involvement; Patient Questionnaires – Questionnaires will be sent to Enrollees who are suspected of having suffered an injury as a result of an accident; and Questionnaires will be based on a predetermined diagnosis code range. Medical Management The Contractor shall identify any requested medical services related to motor vehicle accidents, or work related injuries, and refer these claims to the recoveries specialist for further investigation.