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. 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.
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. Claims must conform to a format that is currently specified, accepted, and supported by DBH consistent with the Administrative Simplification Provisions of the Health Insurance Portability and Accountability Act (HIPAA).
Claims Submission Requirements. For APM Years 1 and 2: 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.
