Claims Submissions Sample Clauses
The Claims Submissions clause outlines the procedures and requirements for submitting claims under a contract or insurance policy. It typically specifies the timeframe within which claims must be filed, the documentation or evidence required, and the method of submission, such as through a designated portal or in writing. By establishing clear guidelines for how and when claims should be submitted, this clause helps ensure timely processing and reduces disputes over eligibility or payment.
Claims Submissions. Practice shall submit all claims and encounter data for Covered Services provided to Enrollees by Participating Physicians in accordance with form and format requirements of HMHP or the applicable Payor.
Claims Submissions a. The Contractor shall submit claims to AHCCCS in accordance with the ADHS/DBHS Program Support Procedures Manual, ADHS/DBHS Provider Manual, and the Financial Reporting Guide for Regional Behavioral Health Authorities as applicable to 638 contracted facilities. The Contractor shall meet all timeliness requirements of submitting claims as outlined in the ADHS/DBHS Program Support Procedures Manual. The Contractor shall meet all claims submission requirements including timeliness of claims or be subject to financial sanction.
b. The Contractor shall require subcontracted providers to submit claims for every service rendered to a client in accordance with claims submission requirements outlined in the ADHS/DBHS Provider Manual and the AHCCCS Fee-for-Services Manual.
c. The Contractor shall participate in data validations studies in accordance with Terms and Conditions Paragraph G. Compliance Provisions and the ADHS/DBHS Program Support Procedures Manual as applicable to 638 contracted facilities.
Claims Submissions. The Employer will ensure that any claims for benefits submitted by the employee due to the job related injury are forwarded to the appropriate authorities as soon as possible.