Common use of Quantitative Results Clause in Contracts

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Dignity Health (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Dignity Health. iii. Total dollar amount of all Overpayments in each Discovery Sample and each Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in each Discovery Sample and each Full Sample (if applicable) and the net Overpayment associated with each Discovery Sample and each Full Sample (if applicable). v. Error Rate in each Discovery Sample and each Full Sample (if applicable). vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by ▇▇▇▇▇, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount. vii. If a Full Sample is performed, the methodology used by the IRO to estimate the actual Overpayment in the Population and the amount of such Overpayment.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Dignity Health MCCG (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Dignity HealthMCCG. iii. Total dollar amount of all Overpayments in each the Discovery Sample and each the Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in each the Discovery Sample and each the Full Sample (if applicable) and the net Overpayment associated with each the Discovery Sample and each the Full Sample (if applicable)Sample. v. Error Rate in each the Discovery Sample and each the Full Sample (if applicable)Sample. vi. A spreadsheet of the Claims Inpatient Medical Necessity and Appropriateness Review results that includes the following information for each Paid Claim: the IRO’s determination regarding whether the inpatient admission and length of stay were medically necessary and appropriate and, for any inpatient admission that the IRO determines was not medically necessary and appropriate, the following information: Federal health care program billed, beneficiary health insurance claim number, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursed, allowed amount reimbursed by ▇▇▇▇▇payor, correct code (as determined by the IRO), correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount. vii. If a Full Sample is performed, the methodology used by the IRO to estimate the actual Overpayment in the Population and the amount of such Overpayment.

Quantitative Results. i. Total number and percentage of instances in which the IRO determined that the Paid Claims submitted by Dignity Health CareMed (Claim Submitted) differed from what should have been the correct claim (Correct Claim), regardless of the effect on the payment. ii. Total number and percentage of instances in which the Claim Submitted differed from the Correct Claim and in which such difference resulted in an Overpayment to Dignity HealthCareMed. iii. Total dollar amount of all Overpayments in each the Discovery Sample and each the Full Sample (if applicable). iv. Total dollar amount of Paid Claims included in each the Discovery Sample and each the Full Sample (if applicable) and the net Overpayment associated with each the Discovery Sample and each the Full Sample (if applicable).Sample. Corporate Integrity Agreement between the Office of Inspector General and Sorkin’s Rx Ltd. d/b/a CareMed Pharmaceutical Services v. Error Rate in each the Discovery Sample and each the Full Sample (if applicable)Sample. vi. A spreadsheet of the Claims Review results that includes the following information for each Paid Claim: Federal health care program billed, beneficiary health insurance claim number, national drug code (NDC) and amount dispensed, date of service, code submitted (e.g., DRG, CPT code, etc.), code reimbursedamount claimed, allowed amount reimbursed by ▇▇▇▇▇, correct code (as determined by the IRO)payor, correct allowed amount (as determined by the IRO), dollar difference between allowed amount reimbursed by payor and the correct allowed amount. vii. If a Full Sample is performed, the methodology used by the IRO to estimate the actual Overpayment in the Population and the amount of such Overpayment.