Claims Subject to Quality Improvement and Utilization Management Programs. Payment for claims shall be subject to the Quality Improvement programs of the health plan companies and CCMI, including authorization, concurrent and retrospective peer review. All coding must be in compliance the federal departments of Health and Human Services and CMS, with the Rules and Regulations of CCMI, its designees, and health plan companies regarding coding guidelines such as CPT, IDC-9CM and HCPCS, as interpreted by CCMI, its designees, or a health plan company. Failure to comply with the requirements of this Agreement, particularly this Article III and Article IV., may result in non-payment.
