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.
Appears in 4 contracts
Samples: Provider Agreement, Provider Agreement, Provider Agreement
Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCPMCOP’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 MCOP shall have policies and procedures implemented to identify, communicate, and correct CPSEs.
2. The MCP MCOP shall submit the CPSEs to ODM based on the ODM calendar of submissions schedule.
3. The MCP MCOP shall follow all CPSE template instructions and guidelines.
4. The MCP MCOP 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.
Appears in 1 contract
Samples: Provider Agreement
