Common use of Claims Management System Clause in Contracts

Claims Management System. The CMHSP shall make timely payments to all providers for clean claims. This includes payment at 90% or higher of all clean claims from affiliates and network sub-contractors within 30 days of receipt, and at least 99% of all clean claims within 90 days of receipt, except services rendered under a sub-contract in which other timeliness standards have been specified and agreed to by both parties. A clean claim is a valid claim completed in the format and time frames specified by the CMHSP and that can be processed without obtaining additional information from the provider of service or a third party. It does not include a claim from a provider who is under investigation for fraud. A valid claim is a claim for supports and services that the CMHSP is responsible for under this contract. The CMHSP shall have an effective provider appeal process to promptly and fairly resolve provider billing disputes.

Claims Management System. The CMHSP shall make timely payments to all providers for clean claims. This includes payment at 90% or higher of all clean claims from affiliates and network sub-sub- contractors within 30 days of receipt, and at least 99% of all clean claims within 90 days of receipt, except services rendered under a sub-contract in which other timeliness standards have been specified and agreed to by both parties. A clean claim is a valid claim completed in the format and time frames specified by the CMHSP and that can be processed without obtaining additional information from the provider of service or a third party. It does not include a claim from a provider who is under investigation for fraudfraud or abuse, or a claim under review for medical necessity (Children’s Waiver and SEDW only). A valid claim is a claim for supports and services that the CMHSP is responsible for under this contract. The CMHSP shall have an effective provider appeal process to promptly and fairly resolve provider billing disputes.

Claims Management System. The CMHSP shall make timely payments to all providers for clean claims. This includes payment at 90% or higher of all clean claims from affiliates and network sub-contractors within 30 days of receipt, and at least 99% of all clean claims within 90 days of receipt, except services rendered under a sub-contract in which other timeliness standards have been specified and agreed to by both parties. A clean claim is a valid claim completed in the format and time frames specified by the CMHSP and that can be processed without obtaining additional information from the provider of service or a third party. It does not include a claim from a provider who is under investigation for fraudfraud or abuse, or a claim under review for medical necessity. A valid claim is a claim for supports and services that the CMHSP is responsible for under this contract. The CMHSP shall have an effective provider appeal process to promptly and fairly resolve provider billing disputes.

Claims Management System. The CMHSP shall make timely payments to all providers for clean claims. This includes payment at 90% or higher of all clean claims from affiliates and network sub-contractors within 30 days of receipt, and at least 99% of all clean claims within 90 days of receipt, except services rendered under a sub-contract in which other timeliness standards have been specified and agreed to by both parties. A clean claim is a valid claim completed in the format and time frames specified by the CMHSP and that can be processed without obtaining additional information from the provider of service or a third party. It does not include a claim from a provider who is under investigation for fraudfraud or abuse, or a claim under review for medical necessity (Children’s Waiver and SEDW only). A valid claim is a claim for supports and services that the CMHSP is responsible for under this contract. The CMHSP shall have an effective provider appeal process to promptly and fairly resolve provider billing disputes.