BILLING AUDITS, DOCUMENTATION AND RECORDS RETENTION Sample Clauses

BILLING AUDITS, DOCUMENTATION AND RECORDS RETENTION. X. Xxxxxxxxx Visits do not require prior authorization. All service delivery, both managed and unmanaged, require documentation and record retention in accordance with this section. B. The Contractor shall participate in and use best efforts to comply with the BH I/DD Tailored Plan’s Utilization Management (UM) process, which may include requirements for pre-authorization, concurrent review and care management, credentialing review, and a retrospective utilization review of services provided for Members whose services are reimbursed by the BH I/DD Tailored Plan. The Contractor shall provide the BH I/DD Tailored Plan with all necessary clinical information for the BH I/DD Tailored Plan’s UM process. For purposes of this Article II Section 4, Contractor shall provide specifically denominated clinical or encounter information required by the BH I/DD Tailored Plan to meet State and Federal monitoring requirements within fifteen (15) calendar days of the request, except that BH I/DD Tailored Plan may grant additional time to respond for good cause shown and depending upon the size and scope of the request. Additionally, Contractor will provide any documentation directly to the BH I / DD Tailored Plan for review when requested. Contractor may satisfy any request for information by either paper or electronic/digital means. C. The Contractor shall be responsible for completion of all necessary and customary documentation required for the services provided under this Contract in accordance with Controlling Authority. D. Documentation must support the billing diagnosis, the number of units provided and billed, and the standards of the billing code. The Contractor will be responsible for the adoption, assessment, collection, and disposition of fees in accordance with G.S. 122C- 146. E. The Contractor shall maintain all documentation and records supporting Member’s medical necessity for the services and shall provide it to the BH I/DD Tailored Plan for an investigation, audit or review upon request, within time frames established by the BH I/DD Tailored Plan, except that BH I/DD Tailored Plan may grant additional time to respond for good cause shown and depending upon the size and scope of the request. X. The Contractor agrees and understands that the BH I/DD Tailored Plan may inspect financial records concerning claims paid on behalf of Members, records of staff who delivered or supervised the delivery of paid services to Member demonstrating compliance with Controll...
Sample 1See All (10)
AutoNDA by SimpleDocs

Related to BILLING AUDITS, DOCUMENTATION AND RECORDS RETENTION

  • Medical Records Retention Grantee shall retain medical records in accordance with 22 TAC §165.1(b) or other applicable statutes, rules and regulations governing medical information.

  • Records Retention PROVIDER will preserve all contracting information, as defined under Texas Government Code, Section 552.003 (7), related to the Agreement for the duration of the Agreement and for seven years after the conclusion of the Agreement.

  • Records Retention and Access 1. Grantee will keep and maintain, as applicable, accurate and complete records necessary to determine compliance with this Contract and applicable laws. 2. Grantee will provide access to its records to DFPS, the Texas State Auditor’s Office (SAO), the Federal Government, and their authorized representatives. 3. Unless otherwise specified in this Contract, Grantee will maintain legible copies of this Contract and all related documentation for a minimum of seven years after the termination of this Contract or seven years after the completion of any litigation or dispute involving the Contract, whichever is longer. 4. THE GRANTEE WILL NOT DISPOSE OF RECORDS BEFORE PROVIDING THE DFPS CONTRACT MANAGER WRITTEN NOTICE OF ITS INTENT TO DISPOSE OF RECORDS AND RECEIVING WRITTEN APPROVAL FROM THE DFPS CONTRACT MANAGER.

  • Inspection and Retention of Records In addition to any other requirement under this Agreement or at law, Party must fulfill all state and federal legal requirements, and will comply with all requests appropriate to enable the Agency of Human Services, the U.S. Department of Health and Human Services (along with its Inspector General and the Centers for Medicare and Medicaid Services), the Comptroller General, the Government Accounting Office, or any of their designees: (i) to evaluate through inspection or other means the quality, appropriateness, and timeliness of services performed under this Agreement; and (ii) to inspect and audit any records, financial data, contracts, computer or other electronic systems of Party relating to the performance of services under Vermont’s Medicaid program and Vermont’s Global Commitment to Health Waiver. Party will retain for ten years all documents required to be retained pursuant to 42 CFR 438.3(u).

  • Maintenance of Books and Records; Record Retention 5.1. Ultimus shall maintain and keep current the accounts, books, records and other documents relating to the Services as may be required by applicable law, rules, and regulations, including Federal Securities Laws as defined under Rule 38a-1 under the Investment Company Act.

  • Documentation and compliance (a) The data importer shall promptly and adequately deal with enquiries from the data exporter that relate to the processing under these Clauses. (b) The Parties shall be able to demonstrate compliance with these Clauses. In particular, the data importer shall keep appropriate documentation on the processing activities carried out on behalf of the data exporter. (c) The data importer shall make available to the data exporter all information necessary to demonstrate compliance with the obligations set out in these Clauses and at the data exporter’s request, allow for and contribute to audits of the processing activities covered by these Clauses, at reasonable intervals or if there are indications of non-compliance. In deciding on a review or audit, the data exporter may take into account relevant certifications held by the data importer.

  • Performance of Services in Accordance with Regulatory Requirements; Furnishing of Books and Records In performing the services set forth in this Agreement, the Manager: A. shall conform with the 1940 Act and all rules and regulations thereunder, with all other applicable federal, state and foreign laws and regulations, with any applicable procedures adopted by the Trust’s Board of Trustees, and with the provisions of the Trust’s Registration Statement filed on Form N-1A as supplemented or amended from time to time; B. will make available to the Trust, promptly upon request, any of the Fund’s books and records as are maintained under this Agreement, and will furnish to regulatory authorities having the requisite authority any such books and records and any information or reports in connection with the Manager’s services under this Agreement that may be requested in order to ascertain whether the operations of the Trust are being conducted in a manner consistent with applicable laws and regulations.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!