BILLING AUDITS, DOCUMENTATION AND RECORDS RETENTION Sample Clauses

BILLING AUDITS, DOCUMENTATION AND RECORDS RETENTION a. Unmanaged visits do not require prior authorization. All service delivery, both managed and unmanaged, require documentation and record retention in accordance with this section.
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BILLING AUDITS, DOCUMENTATION AND RECORDS RETENTION. Unmanaged visits do not require prior authorization. All service delivery, both managed and unmanaged, require documentation and record retention in accordance with this section. The LIP shall participate in and use best efforts to comply with the LME/PIHP’s Utilization Management process, which may include requirements for pre-authorization, concurrent review and care management, credentialing review, and a retrospective utilization review of services provided for Enrollees whose services are reimbursed by the LME/PIHP. The LIP shall provide the LME/PIHP with all necessary clinical information for the LME/PIHP’s utilization management process. LIP shall provide specifically denominated clinical or encounter information required by the LME/PIHP to meet State and Federal monitoring requirements within fifteen (15) calendar days of the request, except that LME/PIHP may grant additional time to respond for good cause shown and depending upon the size and scope of the request. Additionally, LIP will provide any documentation directly to the LME/PIHP for review when requested. LIP may satisfy any request for information by either paper or electronic/digital copy. The LIP shall be responsible for completion of all necessary and customary documentation required for the services provided under the Contract in accordance with all Controlling Authority. Documentation must support the billing diagnosis, the number of units provided and billed, and the standards of the billing code. The LIP will be responsible for the adoption, assessment, collection, and disposition of fees in accordance with G.S. 122C-146; and LIP shall maintain all documentation and records supporting Enrollees’ medical necessity for the services and shall provide it to the LME/PIHP within fifteen (15) days of requests for program integrity activities, including but not limited to audits, investigations or post-payment reviews, except that LME/PIHP may grant additional time to respond for good cause shown and depending upon the size and scope of the request. The LIP agrees and understands that the LME/PIHP may inspect financial records concerning claims paid on behalf of Enrollees, records of staff who delivered or supervised the delivery of paid services to Enrollees demonstrating compliance with Controlling Authority, Enrollee’s clinical records, and any other clinical or financial items related to the claims paid on behalf of Enrollees deemed necessary to assure compliance with the Contract. LIP...
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BILLING AUDITS, DOCUMENTATION AND RECORDS RETENTION a. The Contractor shall participate in and use best efforts to comply with the LME/PIHP’s Utilization Management process, which may include requirements for pre-authorization, concurrent review and care management, credentialing review, and a retrospective utilization review of services provided for Enrollees whose services are reimbursed by the LME/PIHP. The Contractor shall provide the LME/PIHP with all necessary clinical information for the LME/PIHP’s utilization management process. Contractor shall provide specifically denominated clinical or encounter information required by the LME/PIHP to meet State and Federal monitoring requirements within fifteen (15) days of the request, except that LME/PIHP 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 requested documentation directly to the Department upon notification by the LME/PIHP or the Department of required documents for review. Contractor may satisfy any request for information by either paper or electronic/digital means.
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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.
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Related to BILLING AUDITS, DOCUMENTATION AND RECORDS RETENTION

  • Documentation and Record Keeping 1. Records to be Maintained Subrecipient shall maintain all records required by the Federal regulations specified in 24 CFR 570.506 that are pertinent to the activities to be funded under this Contract. Such records shall include, but not be limited to:

  • Medical Records Retention Grantee will;

  • Records Retention The Asset Representations Reviewer will maintain copies of Review Materials, Review Reports and internal work papers and correspondence (collectively the “Client Records”) for a period of two years after the termination of this Agreement. At the expiration of the retention period, the Asset Representations Reviewer shall return all Client Records to the Servicer, in electronic format or, to the extent held in tangible form, in that form. Upon the return of the Client Records, the Asset Representations Reviewer shall have no obligation to retain such Client Records or to respond to inquiries concerning any Asset Review.

  • Records Retention and Examination Contractor shall retain, protect, and maintain in an accessible location all records and documents, including paper, electronic, and computer records, relating to this Contract for five (5) years after receipt of final payment by City under this Contract. Contractor shall make all such records and documents available for inspection, copying, or other reproduction, and auditing by authorized representatives of City, including the Purchasing Agent or designee. Contractor shall make available all requested data and records at reasonable locations within City or County of San Diego at any time during normal business hours, and as often as City deems necessary. If records are not made available within the City or County of San Diego, Contractor shall pay City’s travel costs to the location where the records are maintained and shall pay for all related travel expenses. Failure to make requested records available for inspection, copying, or other reproduction, or auditing by the date requested may result in termination of the Contract. Contractor must include this provision in all subcontracts made in connection with this Contract.

  • Document Retention and Record Maintenance The HSP will

  • Records Retention Contractors and Subcontractors must preserve such certified transcripts for a period of three years from the date of completion of work on the awarded contract.

  • Examination and Retention of Contractor's Records (a) The HA, HUD, or Comptroller General of the United States, or any of their duly authorized representatives shall, until 3 years after final payment under this contract, have access to and the right to examine any of the Contractor's directly pertinent books, documents, papers, or other records involving transactions related to this contract for the purpose of making audit, examination, excerpts, and transcriptions.

  • Records Retention and Access The Contractor shall maintain accurate, current, and complete records of the financial activity of this Contract which sufficiently and properly document and calculate all charges billed to the Agency throughout the term of this Contract and for a period of at least five (5) years following the date of final payment or completion of any required audit (whichever is later). If any litigation, claim, negotiation, audit or other action involving the records has been started before the expiration of the five (5) year period, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five (5) year period, whichever is later. The Contractor shall permit the Agency, the Auditor of the State or any other authorized representative of the State and where federal funds are involved, the Comptroller General of the United States or any other authorized representative of the United States government, to access and examine, audit, excerpt and transcribe any directly pertinent books, documents, papers, electronic or optically stored and created records or other records of the Contractor relating to orders, invoices or payments or any other documentation or materials pertaining to this Contract, wherever such records may be located. The Contractor shall not impose a charge for audit or examination of the Contractor’s books and records. Based on the audit findings, the Agency reserves the right to address the Contractor’s board or other managing entity regarding performance and expenditures. When state or federal law or the terms of this Contract require compliance with OMB Circular A-87, A-110, or other similar provision addressing proper use of government funds, the Contractor shall comply with these additional records retention and access requirements:

  • 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).

  • 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.

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