Authenticity, Record requirements, Certifications Clause Samples
The 'Authenticity, Record Requirements, Certifications' clause establishes the obligation for parties to maintain and provide genuine records and necessary certifications related to their contractual obligations. In practice, this means parties must keep accurate documentation, such as receipts, compliance certificates, or other proof of authenticity, and present them upon request or as stipulated in the agreement. This clause ensures that all parties can verify compliance and the legitimacy of goods, services, or actions, thereby reducing the risk of fraud and supporting accountability.
Authenticity, Record requirements, Certifications. Trading Partner and Health Plan agree that the electronic transmission of information in response to inquiries is no guarantee of payment and does not change any of the conditions under which Health Plan is obligated to pay health care claims submitted on behalf of Health Plan’s covered members. Trading Partner shall ensure that each and every transaction is capable of being associated with services actually being rendered, or under consideration of services to be rendered, by a health care provider contracting with Trading Partner to the member identified on the transaction. Trading Partner agrees to retain such information, documents, and records supporting the electronic inquiries submitted in their original format for at least one year after they are first submitted to Health Plan.
Authenticity, Record requirements, Certifications. Trading Partner and Health Plan agree that the fact that claims for payment are submitted via electronic methods does not change any of the conditions under which Health Plan is obligated to pay claims. Trading Partner agrees to maintain all the same records documenting that care was in fact rendered, which services were rendered, and at what appropriate price, cost, or reimbursement from Health Plan, as if the claims for those services were submitted on the paper forms otherwise required by Health Plan. Trading Partner shall assure that every claim submission is capable of being associated with original copies of source documents pertaining to any particular claim, including any Medicare claims, (such as patient medical records, billing records, attestation forms, Certificates of Medical Necessity (CMNs) for certain DME or other claim types, physician or patient signatures, etc.) in such form as may be required by Health Plan or any government agency. Trading Partner agrees to retain such information, documents and records in their original format for at least six years after it was first submitted to Health Plan. On each and every occasion when Trading Partner submits claims via electronic methods, Trading Partner shall be deemed to certify that the services were indeed rendered in the manner and amount as set forth on the claims which Trading Partner has caused to be submitted to Health Plan in electronic media and shall be deemed to have signed or attested to the same clauses which Health Plan requires for similar claims submitted on paper. Trading Partner will not assert at any time, in any form, that Trading Partner is not bound by the accuracy or authenticity of claims data submitted via electronic means on the basis that Trading Partner (or its agent) has not signed a certification of attestation form as ordinarily set forth on paper claim otherwise required by Health Plan or by any applicable law or regulation