Claims Submission and Payment. Members shall review and approve timesheets of their Providers to determine accuracy and appropriateness. No SDCB Provider shall exceed forty (40) hours paid work in a consecutive seven (7) Calendar Day period. Payments to SDCB Providers shall comply with State and federal minimum wage statutes and regulations. Timesheets must be submitted and processed on a two (2) week pay schedule according to HCA’s prescribed payroll payment schedule. The FMA shall be responsible for processing payments for approved services and goods. The CONTRACTOR shall reimburse the FMA for authorized SDCB services provided by Providers at the appropriate rate for the self-directed HCBS, which includes applicable payroll taxes. Value Added Services The CONTRACTOR may offer Value Added Services to its Members that are not Covered Services (see Attachments 1 and 4). The CONTRACTOR is encouraged to consider the unique and unmet needs of Members and, where appropriate, their families or Caregivers when proposing Value Added Services. Value Added Services must be prior approved in writing by HCA. The cost of Value Added Services will not be included in the Capitation Rate. All Value Added Services shall be identifiable and measurable through the use of unique payment and/or processing codes, approved by HCA. At the CONTRACTOR’s request, HCA may assist in identifying a compliant code. The CONTRACTOR shall send Members notices of Adverse Benefit Determination regarding Value Added Services that comply with the requirements in the Managed Care Policy Manual. Denial of a Value Added Service will not be considered an Adverse Benefit Determination for purposes of Appeals or Fair Hearings. Provider Network
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Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
Claims Submission and Payment. Members shall review and approve timesheets of their Providers to determine accuracy and appropriateness. No SDCB Provider shall exceed forty (40) hours paid work in a consecutive seven (7) Calendar Day period. Payments to SDCB Providers shall comply with State and federal minimum wage statutes and regulations. Timesheets must be submitted and processed on a two (2) week pay schedule according to HCAHSD’s prescribed payroll payment schedule. The FMA shall be responsible for processing payments for approved services and goods. The CONTRACTOR shall reimburse the FMA for authorized SDCB services provided by Providers at the appropriate rate for the self-directed HCBS, which includes applicable payroll taxes. Value Added Services The CONTRACTOR may offer Value Added Services to its Members that are not Covered Services (see Attachments 1 and 4). The CONTRACTOR is encouraged to consider the unique and unmet needs of Members and, where appropriate, their families or Caregivers when proposing Value Added Services. Value Added Services must be prior approved in writing by HCAHSD. The cost of Value Added Services will not be included in the Capitation Rate. All Value Added Services shall be identifiable and measurable through the use of unique payment and/or processing codes, approved by HCAHSD. At the CONTRACTOR’s request, HCA HSD may assist in identifying a compliant code. The CONTRACTOR shall send Members notices of Adverse Benefit Determination regarding Value Added Services that comply with the requirements in the Managed Care Policy Manual. Denial of a Value Added Service will not be considered an Adverse Benefit Determination for purposes of Appeals or Fair Hearings. Provider Network
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