Cost Avoidance Activities Sample Clauses
The 'Cost Avoidance Activities' clause defines the measures and actions that a party must take to minimize or prevent unnecessary expenses during the performance of a contract. This may include seeking alternative suppliers, optimizing resource use, or implementing efficiency improvements to reduce costs. By requiring proactive efforts to avoid incurring avoidable costs, the clause helps ensure that both parties benefit from prudent financial management and that the overall contract value is preserved.
Cost Avoidance Activities a. The Contractor shall be responsible for cost avoidance through the Coordination of Benefits (COB) for public and private resources, including but not limited to Medicare, private health insurance, Employee Retirement Income Security Act of 1974 (ERISA), 29 U.S.C. §§ 1001, et. seq., plans, and workers' compensation. The Contractor must attempt to avoid initial payment of Claims, whenever possible, where public or private resources are available. All cost• avoided funds must be reported to the Department on a form approved by the Department, showing that TPL has been pursued and the amount which has been cost- avoided. The Contractor shall not be held responsible for any TPL errors in the Department's Eligibility Verification System (EVS) or the Department's TPL file.
b. The Contractor may not deny or delay approval of otherwise covered treatment or services based upon TPL considerations. The Contractor may neither unreasonably delay payment nor deny payment of claims unless it has established the probable existence of TPL at the time the claim is adjudicated.
Cost Avoidance Activities i. The Contractor will have primary responsibility for cost avoidance through the Coordination of Benefits (COB) relative to federal and private health insurance-type resources including, but not limited to, Medicare, private health insurance, Employees Retirement Income Security Act of 1974 (ERISA), 29 U.S.C.A. 1396a(a)(25) plans, and workers compensation. The Contractor must attempt to avoid initial payment of Claims, whenever possible, where federal or private health insurance-type resources are available. All cost-avoided funds must be reported to the Commonwealth via encounter data submissions and financial report 8A-D. The use of the COB flag, Medicare fields, and the Other Insurance Paid (OIP) field shall indicate that TPL has been pursued and the amount which has been cost-avoided. The Contractor shall not be held responsible for any TPL errors in the Department's Eligibility Verification System (EVS) or the Department's TPL file. 119
ii. The Contractor agrees to pay, and to require that its subcontractors pay, all Clean Claims for prenatal or preventive pediatric care (including EPSDT services to children), and services to children having medical coverage under a Title IV-D child support order to the extent the Contractor is notified by the Department of such support orders or to the extent the Contractor becomes aware of such orders, and then seek reimbursement from liable third parties. The Contractor recognizes that cost avoidance of these Claims is prohibited with the exception of hospital delivery Claims, which may be cost-avoided.
iii. The Contractor may not deny or delay approval of otherwise covered treatment or services based upon third party liability considerations. The Contractor may neither unreasonably delay payment nor deny payment of Claims unless the probable existence of third party liability is established at the time the Claim is filed.
Cost Avoidance Activities i. The PCO must take measures to avoid initial payment of Claims, whenever possible, where federal or private insurance-type resources are available. The PCO must report all funds that are cost avoided to the Department via Encounter Data submissions. The use of the appropriate HIPAA 837 Loop(s) for Medicare and Other Insurance Paid (OIP) shall indicate that TPL has been pursued and the amount which has been cost-avoided.
ii. The PCO may not deny or delay approval of otherwise covered treatment or services based upon TPL considerations. The PCO may neither unreasonably delay payment nor deny payment of Claims unless the probable existence of TPL is established at the time the Claim is adjudicated.
Cost Avoidance Activities. Post-Payment Recoveries.................................................................