Coverage and Reimbursement. Code Look-Up Tool means the Department’s coverage and reimbursement code database located on the Department’s official website. Date of Discovery means the identification of an Overpayment by any governmental entity, Provider, or Contractor and the date on which communication of that Overpayment finding or the initiation of a formal recoupment action without notice as described in 42 CFR 433.316. Delivery Case Rate means a single supplemental payment for maternity delivery costs. Disclosing Entity means a Medicaid Provider (other than an individual practitioner or group of practitioners), or a Fiscal Agent. For purposes of the Contract, Disclosing Entity means the Contractor. Division of Occupational and Professional Licensing (DOPL) means an agency within the Utah Department of Commerce which administers and enforces specific laws related to the licensing and regulation of certain occupations and professions. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program means the federally mandated program as defined in 42 CFR Part 441, Subpart B, that provides comprehensive and preventive health care services for children. Electronic Resource Eligibility Product (eREP) means the computer support system used by eligibility workers to determine Medicaid eligibility and store eligibility information. Eligibility Transmission means the 834 Benefit Enrollment and Maintenance File. Emergency Medical Condition means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in:
Appears in 4 contracts
Samples: medicaid.utah.gov, medicaid.utah.gov, medicaid.utah.gov
