Accounting and Claims Processing Sample Clauses

Accounting and Claims Processing. 1) Provider must maintain an accounting and claims processing system compliant with G.S. 159-26 and shall have proper internal controls to ensure proper record keeping and generally accepted accounting procedures are continually in place.
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Accounting and Claims Processing. Provider must maintain an accounting and claims processing system compliant with N.C. GenStat. §159-26 and shall have proper internal controls to ensure proper record keeping and generally accepted accounting procedures are continually in place. Provider must have a system in place that allows an audit to be completed for Enrollee accounts. In the event an overpayment of funds is found during an audit, the Provider must repay said funds within 30 days to LME. Billing Enrollee eligible for Medicaid are not eligible to receive IPRS/State Funding. IPRS funds are a payer of last resort. Providers must collect first and third-party revenue. The Provider must have a system in place to monitor such activity and subsequently repay any related amounts to Enrollees. Best Practice Model Provide/coordinate psychiatric services along with clinical home for these Enrollees if in the person-centered plan. Assure all Enrollees have choice of provider and these processes are followed for transition of Enrollees as well as referrals. Providers must fully comply with First Responder duties. Committee Participation LME would like the Provider to attend or actively participate in the Community Collaborative process for children’s families and attend work groups or committees as invited by LME. Authorizations Providers will comply with the following regarding service authorizations. Submit authorization requests at least 14 days before the end of an existing authorization. Limit request(s) to service type, scope and duration that is medically necessary and consistent with IPRS benefit grids. Submit all documentation that is requested by LME staff to conduct Utilization Review within timeframes communicated. In order for LME to report pertinent information to federal, state and local authorities (as mandated by various contracts and agreements), providers are expected to submit the data listed below according to the related timelines. In order to ensure timely payment, all required information must be submitted as detailed below. Providers will acknowledge all referrals (accept the referral) made to them via the Slot Scheduler via Provider Portal within 24 hours or next business day, by checking the acknowledgement checkbox in the referral. If a Provider is unable to acknowledge (accept) the referral they will email Customer Services at XxxxxxXxxxx@xxxxxxxxxxx.xxx and inform Customer Services that the Enrollee will need to be scheduled with another provider and why. Areas of rep...
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Related to Accounting and Claims Processing

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