Common use of Compliance with Medicaid Laws and Regulations Clause in Contracts

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor or Health Plan provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan United or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan United constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor State or Health Plan United provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan United performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan United upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations regulations, including applicable sub regulatory guidance, and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan United or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan United constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor State or Health Plan United provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan United performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan United upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan or the State Department is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or or Health Plan constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor or Health Plan provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Health Plan, Subcontractor, Health Plan or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan and/or Subcontractor constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor or Health Plan or Subcontractor provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan or the State Department is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or or Health Plan constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor or Health Plan provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim Claim by Subcontractor, Health Plan Carrier or the State HCA is conditioned upon the claim Claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim Claim the Provider submits to Subcontractor and/or Health Plan Carrier constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims Claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare health care programs. Provider’s payment of a claim Claim may be temporarily suspended if the State, Subcontractor or Health Plan Carrier provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan Xxxxxxx performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan Carrier upon its request in order to determine appropriateness of coding. Claims payments may be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or or Health Plan constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, State or Subcontractor or Health Plan provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan Subcontractor or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, State or Subcontractor or Health Plan provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by SubcontractorSubcontractor or Health Plan, Health Plan or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination debarment and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or or Health Plan Plan, constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, State or Subcontractor or Health Plan Plan, provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan Plan, performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or or Health Plan Plan, upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan and/or Subcontractor or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan and/or Subcontractor constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor State or Health Plan and/or Subcontractor provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan and/or Subcontractor performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan and/or Subcontractor upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim Claim by Subcontractor, Health Plan Carrier or the State HCA (as applicable) is conditioned upon the claim Claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination debarment and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim Claim the Provider submits to Subcontractor and/or Health Plan or Carrier constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims Claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim Claim may be temporarily suspended if the State, Subcontractor or Health Plan Carrier provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Carrier and Subcontractor and/or Health Plan performs perform coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Carrier and Subcontractor and/or Health Plan upon its their request in order to determine appropriateness of coding. Provider Claims payments may dispute any be temporarily suspended or adjusted payment consistent if the Provider bills a claim with a code that does not match the terms of the Agreementservice provided.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by SubcontractorSubcontractor or Health Plan, Health Plan or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or or Health Plan Plan, constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, State or Subcontractor or Health Plan Plan, provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan Plan, performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or or Health Plan Plan, upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan Subcontractor or the State District of Columbia is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, District of Columbia or Subcontractor or Health Plan provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan and/or Subcontractor or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination debarment and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan and/or Subcontractor constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor State or Health Plan provides and/or Subcontractor provide notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan and/or Subcontractor performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan and/or Subcontractor upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Health Plan United or the State Department is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan United constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor or Health Plan United provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan United performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan United upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations regulations, including applicable sub regulatory guidance, and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Subcontractor and/or Health Plan or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor or Subcontractor, Health Plan provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.

Compliance with Medicaid Laws and Regulations. Provider agrees to abide by the Medicaid laws, regulations regulations, including applicable sub regulatory guidance, and program instructions to the extent applicable to Provider in Provider’s performance of the Agreement. Provider understands that payment of a claim by Subcontractor, Subcontractor and/or Health Plan or the State is conditioned upon the claim and the underlying transaction complying with such laws, regulations, and program instructions (including, but not limited to, federal requirements on fraud, waste and abuse, disclosure, debarment, termination debarment and exclusion screening), and is conditioned on the Provider’s compliance with all applicable conditions of participation in Medicaid. Provider understands and agrees that each claim the Provider submits to Subcontractor and/or Health Plan constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State, Subcontractor or Subcontractor, Health Plan provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor and/or Health Plan performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor and/or Health Plan upon its request in order to determine appropriateness of coding. Provider may dispute any temporarily suspended or adjusted payment consistent with the terms of the Agreement.