Definition of Contracted Sample Clauses

Definition of Contracted. Provider Dispute. A “contracted provider dispute” is a provider’s written notice to March Vision Care and/or the Enrollee’s applicable health plan challenging, appealing or requesting reconsideration of a claim (or a bundled group of substantially similar multiple claims that are individually numbered) that has been denied, adjusted or contested or seeking resolution of a billing determination or other contract dispute (or bundled group of substantially similar multiple billing or other contractual disputes that are individually numbered) or disputing a request for reimbursement of an overpayment of a claim. Each contracted provider dispute must contain, at a minimum the following information: 1. provider’s name; 2. provider’s identification number; 3. provider’s contact information; 4. if the contracted provider dispute concerns a claim or a request for reimbursement of an overpayment of a claim from March Vision Care to a provider the following must be provided: a clear identification of the disputed item, the date of service and a clear explanation of the basis upon which the provider believes the payment amount, request for additional information, request for reimbursement for the overpayment of a claim, contest, denial, adjustment or other action is incorrect; if the contracted provider dispute is not about a claim, a clear explanation of the issue and the provider's position on such issue; and 5. if the contracted provider dispute involves an Enrollee or group of Enrollees, the name and identification number(s) of the Enrollee or Enrollees, a clear explanation of the disputed item, including the date of service and provider’s position on the dispute, and written authorization from the Enrollee or Enrollee for provider to represent said Enrollee or Enrollee.