Clean Claim. A claim for payment for a health care service, which has been received by ACDE, has no defect or impropriety. A defect or impropriety shall include a lack of required substantiating documentation or a particular circumstance requiring special treatment that prevents timely payment from being made on the claim. Consistent with 42 CFR §447.45(b), the term shall not include a claim from a health care provider who is under investigation for fraud or abuse regarding that claim, or a claim under review for medical necessity.
Appears in 4 contracts
Samples: Physician Provider Agreement, Provider Services Agreement, Hospital Services Agreement
Clean Claim. A claim for payment for a health care service, which has been received by ACDEACOH, has no defect or impropriety. A defect or impropriety shall include a lack of required substantiating documentation or a particular circumstance requiring special treatment that prevents timely payment from being made on the claim. Consistent with 42 CFR §447.45(b), the term shall not include a claim from a health care provider who is under investigation for fraud or abuse regarding that claim, or a claim under review for medical necessity.
Appears in 2 contracts
Samples: Hospital Services Agreement, Ancillary Services Agreement
Clean Claim. A claim for payment for a health care service, which has been received by ACDEACIA, has no defect or impropriety. A defect or impropriety shall include a lack of required substantiating documentation or a particular circumstance requiring special treatment that prevents timely payment from being made on the claim. Consistent with 42 CFR §447.45(b), the term shall not include a claim from a health care provider who is under investigation for fraud or abuse regarding that claim, or a claim under review for medical necessity.
Appears in 1 contract
Samples: Physician Provider Agreement
