Common use of Claims Payment Systemic Errors (CPSEs) Clause in Contracts

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.

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 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.