Claims Payment Systemic Errors (CPSEs) Sample Clauses

Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCOP’s claims adjudication, including claims adjudication by a contracted vendor, either electronic or manual, incorrectly underpaying, overpaying, or denying claims that impact, or has the potential to impact, five or more providers. ODM reserves the right to request and receive additional information for ODM to classify an issue as a CPSE. 1. The MCOP shall submit the CPSE report and all communications to XxxxxxxxXXXX@xxxxxxxx.xxxx.xxx, unless otherwise directed by ODM, based on the ODM calendar of submissions schedule. A late or incomplete submission is subject to sanctions in accordance with Non-Compliance with CPSEs in Appendix N. 2. The MCOP shall follow all instructions as directed by ODM, including the CPSE reporting template instructions and guidelines. 3. The MCOP shall inform ODM of the status of all active CPSEs on the monthly report by including the following: a. A detailed description and scope of all active CPSEs; b. The date the CPSE was first identified; c. The type(s) of all providers impacted; d. The number of providers impacted; e. The date(s) and method(s) of all provider notifications; f. The timeline for fixing the CPSE; g. The date(s) or date span(s) for all claim adjustment projects or notifications of claim overpayments, if applicable. 4. The MCOP shall report all CPSEs on a monthly CPSE report housed on the MCOP’s Ohio Medicaid website. a. The CPSE report shall be public facing for anyone to view and/or on the MCOP’s provider portal. If the provider portal is used, timely communication of the CPSE must also be made to those providers who are unable to access the CPSE report; b. The CPSE report shall be updated at a minimum once a month, labeled to reflect the updated date; c. The CPSE report shall include, at a minimum, the following information: i. A detailed description and scope of all CPSEs; ii. The date of first identification; iii. The type(s) of providers impacted; iv. The timeline for fixing the CPSE; v. The date of claims adjustments or required provider action. 5. The MCOP shall have a policy and procedure to identify, communicate, and correct CPSEs. The MCOP shall keep the CPSE policy and procedure current to reflect the CPSE requirements. ODM reserves the right to review these and request changes if necessary. The MCOP shall include, at a minimum, all the following in their CPSE policy and procedure: a. The use of input from internal and/or external sources to...
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Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCP’s claims adjudication, either electronic or manual, incorrectly underpaying, overpaying, or denying claims that impact five or more providers. ODM reserves the right to request and receive additional information for ODM to classify an issue as a CPSE. 1. The MCP shall have policies and procedures implemented to identify, communicate, and correct CPSEs. 2. The MCP shall submit the CPSEs to ODM based on the ODM calendar of submissions schedule. 3. The MCP shall follow all CPSE template instructions and guidelines. 4. The MCP shall inform ODM monthly of the status of CPSEs as follows: a. The detailed description and scope of any identified CPSEs including potential CPSEs; b. The date the CPSE was first identified; c. The type of providers impacted; d. The number of providers impacted; e. The date(s) and method(s) of provider notification of the CPSE; f. The projected timeline for fixing the CPSE, including any UAT testing; g. The date(s) for corrected payment/adjustment to providers.
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Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCP’s claims adjudication, either electronic or manual, incorrectly underpaying, overpaying, or denying claims that impact five or more providers. ODM reserves the right to request and receive additional information for ODM to classify an issue as a CPSE. 1. The MCP shall have policies and procedures implemented to identify, communicate, and correct CPSEs. 2. The MCP shall inform ODM monthly of the status of CPSEs as follows: a. The definition and scope of any identified or newly identified CPSE, including the number and type of providers impacted; b. The date of provider notification of the CPSE; c. The projected timeline for fixing the CPSE, including any UAT testing; d. The date(s) for corrected payment/adjustment to providers.
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Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCOP’s claims adjudication, including claims adjudication by a contracted vendor, either electronic or manual, incorrectly underpaying, overpaying, or denying claims that impact, or has the potential to impact, five or more providers. ODM reserves the right to request and receive additional information for ODM to classify an issue as a CPSE. a. The MCOP shall submit the CPSE report and all communications to XxxxxxxxXXXX@xxxxxxxx.xxxx.xxx, unless otherwise directed by ODM, based on the ODM calendar of submissions schedule. A late or incomplete submission is subject to sanctions in accordance with Non-Compliance with CPSEs in Appendix N. b. The MCOP shall follow all instructions as directed by XXX, including the CPSE reporting template instructions and guidelines.
Sample 1

Related to Claims Payment Systemic Errors (CPSEs)

  • Trade Errors The Sub-Advisor will notify the Manager of any Trade Error(s), regardless of materiality, promptly upon the discovery such Trade Error(s) by the Sub-Advisor. Notwithstanding Section 5, the Sub-Advisor shall be liable to the Manager, the Fund or its shareholders for any loss suffered by the Manager or the Fund resulting from Trade Errors due to negligence, misfeasance, or disregard of duties of the Sub Advisor or any of its directors, officers, employees, agents (excluding any broker-dealer selected by the Sub-Advisor), or affiliates. For purposes under this Section 6, “Trade Errors” are defined as errors due to (i) erroneous orders by the Sub-Advisor for the Series that result in the purchase or sale of securities that were not intended to be purchased or sold; (ii) erroneous orders by the Sub-Advisor that result in the purchase or sale of securities for the Series in an unintended amount or price; or (iii) purchases or sales of financial instruments which violate the investment limitations or restrictions disclosed in the Fund’s registration statement and/or imposed by applicable law or regulation (calculated at the Sub-Advisor’s portfolio level), unless otherwise agreed to in writing.

  • Claims Payment The Reinsurer will be liable to the Company for its share of the benefits owed under the express contractual terms of the Reinsured Policies and as specified under the terms of this Agreement. The Reinsurer will not participate in any ex gratia payments made by the Company (i.e., payments the Company is not required to make under the Reinsured Policy terms.) The payment of death benefits by the Reinsurer will be in one lump sum regardless of the mode of settlement under the Reinsured Policy. Benefit payments from the Reinsurer will be due within 30 days of the claim satisfying the requirements established under this Agreement. The Reinsurer’s share of any interest payable under the terms of a Reinsured Policy or applicable law which is based on the death benefits paid by the Company, will be payable provided that the Reinsurer will not be liable for interest accruing on or after the date of the Company’s payment of benefits. The Reinsurer’s share will be based upon the same interest rate and days used by the Company to calculate their interest paid. The Reinsurer will make payment to the Company for each such claim. For Waiver of Premium claims, the Company will continue to pay premiums for reinsurance, except premiums for disability reinsurance. The Reinsurer will pay its proportionate share of the gross premium waived by the Company on the Reinsured Policy, including its share of the premiums for benefits that remain in effect during disability. I414849US-12 (11-01-2011) QT#04028US11 (COLI & BXXx) For claims on Accelerated Benefit riders reinsured under this Agreement, the benefit amount payable by the Reinsurer will be calculated by multiplying the total accelerated death benefit rider payout by the ratio of the reinsured Net Amount at Risk, as defined in Exhibit C -1, to the face amount of the Reinsured Policy.

  • BILLING ERRORS In case of errors or questions about electronic fund transfers from your share and share draft accounts or if you need more information about a transfer on the statement or receipt, telephone us at the following number or send us a written notice to the following address as soon as you can. We must hear from you no later than 60 days after we sent the FIRST statement on which the problem appears. Call us at:

  • Claims Review Population A description of the Population subject to the Claims Review.

  • Claims Submission Unless otherwise prohibited by federal or state law, Provider will submit Clean Claims for all Covered Services to BCBSM within one hundred eighty (180) days of the date of service.

  • Errors, Questions, and Complaints a. In case of errors or questions about your transactions, you should as soon as possible contact us as set forth in Section 6 of the General Terms above. b. If you think your periodic statement for your account is incorrect or you need more information about a transaction listed in the periodic statement for your account, we must hear from you no later than sixty (60) days after we send you the applicable periodic statement for your account that identifies the error. You must: 1. Tell us your name; 2. Describe the error or the transaction in question, and explain as clearly as possible why you believe it is an error or why you need more information; and, 3. Tell us the dollar amount of the suspected error. c. If you tell us orally, we may require that you send your complaint in writing within ten (10) Business Days after your oral notification. Except as described below, we will determine whether an error occurred within ten (10) Business Days after you notify us of the error. We will tell you the results of our investigation within three (3) Business Days after we complete our investigation of the error, and will correct any error promptly. However, if we require more time to confirm the nature of your complaint or question, we reserve the right to take up to forty-five (45) days to complete our investigation. If we decide to do this, we will provisionally credit your Eligible Transaction Account within ten (10) Business Days for the amount you think is in error. If we ask you to submit your complaint or question in writing and we do not receive it within ten (10) Business Days, we may not provisionally credit your Eligible Transaction Account. If it is determined there was no error we will mail you a written explanation within three (3) Business Days after completion of our investigation. You may ask for copies of documents used in our investigation. We may revoke any provisional credit provided to you if we find an error did not occur.

  • Submitting False Claims; Monetary Penalties The AOC shall be entitled to remedy any false claims, as defined in California Government Code section 12650 et seq., made to the AOC by the Contractor or any Subcontractor under the standards set forth in Government Code section 12650 et seq. Any Contractor or Subcontractor who submits a false claim shall be liable to the AOC for three times the amount of damages that the AOC sustains because of the false claim. A Contractor or Subcontractor who submits a false claim shall also be liable to the AOC for (a) the costs, including attorney fees, of a civil action brought to recover any of those penalties or damages, and (b) a civil penalty of up to $10,000 for each false claim.

  • Claims Processing BCBSM will process Provider's Clean Claims submitted in accordance with this Agreement in a timely fashion.

  • Insurance and Fingerprint Requirements Information Insurance If applicable and your staff will be on TIPS member premises for delivery, training or installation etc. and/or with an automobile, you must carry automobile insurance as required by law. You may be asked to provide proof of insurance. Fingerprint It is possible that a vendor may be subject to Chapter 22 of the Texas Education Code. The Texas Education Code, Chapter 22, Section 22.0834. Statutory language may be found at: xxxx://xxx.xxxxxxxx.xxxxx.xxxxx.xx.xx/ If the vendor has staff that meet both of these criterion: (1) will have continuing duties related to the contracted services; and (2) has or will have direct contact with students Then you have ”covered” employees for purposes of completing the attached form. TIPS recommends all vendors consult their legal counsel for guidance in compliance with this law. If you have questions on how to comply, see below. If you have questions on compliance with this code section, contact the Texas Department of Public Safety Non-Criminal Justice Unit, Access and Dissemination Bureau, FAST-FACT at XXXX@xxxxx.xxxxx.xx.xx and you should send an email identifying you as a contractor to a Texas Independent School District or ESC Region 8 and TIPS. Texas DPS phone number is (000) 000-0000. See form in the next attribute to complete entitled: Texas Education Code Chapter 22 Contractor Certification for Contractor Employees

  • CLAIMS SUPPORT The Board shall complete and submit the Trust Plan Administrator’s Waiver of Life Insurance Premium Plan Administrator Statement to the Trust Plan Administrator for life waiver claims when the Trust Plan Administrator does not administer and adjudicate the LTD benefits.

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