Claims Submission Requirements Sample Clauses

Claims Submission Requirements. For Level 1 patients with third party or Medicare insurance, the third party or Medicare will be the primary payer. Differences in these payments received by Contractor and the Reasonable Actual Costs that the State is required to pay Contractor for providing the care under Act 79 will be settled in the Year-End Reconciliation process as set forth in Section 6 of Attachment B.

Claims Submission Requirements. For APM Years 1 and 2:

Claims Submission Requirements. G.1.3.1 All claims must be submitted electronically using the DBH billing system. NSF file layout is based on QuickLink Statewide Health Network Electronic Media Claims National Standard Format, National Version 02.00, Local Version 02.00. More detailed information on each record type can be found there. G.1.3.2 When a specific service is rendered multiple times in a single day, the service must be billed using multiple units rather than as separate line items. G.1.3.3 The Authorization Plan number produced by DBH’s claims adjudication system (currently known as eCura) must be submitted within the claim. The Authorization Plan number will be used to evaluate the dates of service, procedure code, and rendering provider on the claim against what was submitted on the authorization plan. G.1.3.4 For a list of services that cannot be billed on the same date of service, please see the table in Section 6.4.3, Service Combination Authorization Limitations, in the Department’s Billing Manual. G.1.3.5 Except as otherwise permitted under applicable requirements, MHRS Medicaid will be reimbursed if submitted at a time which allows the Department to submit such claims to DHCF within 365 days from the date service was rendered.

Claims Submission Requirements. Subcontractor agrees to timely comply with all claims certification or documentation requirements contained in the Contract Documents or required by applicable law. Subcontractor acknowledges that it has read and is familiar with the provisions of the California False Claims Act (Government Code section 12650 et seq.) and the Federal False Claims Act (31 U.S.C. section 3729 et seq.) (hereinafter "the Acts"). Submission by Subcontractor of any claim to Contractor in connection with the Project shall constitute a representation by Subcontractor to Contractor that the claim is not in any respect in violation of the Acts. In its sole discretion, Contractor may require Subcontractor to certify under penalty of perjury the validity and accuracy of any claim. The claims certification shall be in a form satisfactory to Contractor. Subcontractor's compliance with this claims certification requirement shall be a condition precedent to any obligation Contractor otherwise may have to review the claim or forward it to Owner.