Common use of Excluded Providers Clause in Contracts

Excluded Providers. A. The Contractor shall screen and periodically revalidate all network providers in accordance with the requirements of 42 Code of Federal Regulations, part 455, subparts B and E. (42 C.F.R. §438.602(b).) B. Consistent with the requirements of 42 Code of Federal Regulations, part 455.436, the Contractor must confirm the identity and determine the exclusion status of all providers (employees and network providers) and any subcontractor, as well as any person with an ownership or control interest, or who is an agent or managing employee of the of the Mental Health Plan through routine checks of Federal and State databases. This includes the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE), the System for Award Management (XXX), as well as the Department’s Medi Cal Suspended and Ineligible Provider List (S & I List). (42 C.F.R. §438.602(d).) C. If the Contractor find a party that is excluded, it must promptly notify the Department (42 C.F.R. §438.608(a)(2),(4)) and the Department will take action consistent with 42 C.F.R. §438.610((d). The Contractor shall not certify or pay any excluded provider with Medi-Cal funds, and any such inappropriate payments or overpayments may be subject to recovery and/or be the basis for other sanctions by the appropriate authority.

Excluded Providers. A. i. The Contractor shall screen and periodically revalidate all network providers in accordance with the requirements of 42 Code of Federal Regulations, part 455, subparts B and E. (42 C.F.R. §438.602(b)).) B. ii. Consistent with the requirements of 42 Code of Federal Regulations, part 455.436, the Contractor must confirm the identity and determine the exclusion status of all providers (employees and network providers) and any subcontractor, as well as any person with an ownership or control interest, or who is an agent or managing employee of the of the Mental Health Plan DMC-ODs Network Provider through routine checks of Federal and State databases. This includes the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the Office of Inspector General’s List of Excluded Individuals/Entities (LEIE), the System for Award Management (XXX), as well as the Department’s Medi Cal Suspended and Ineligible Provider List (S & I List). (42 C.F.R. §438.602(d)).) C. iii. If the Contractor find a party that is excluded, it must promptly notify the Department (42 C.F.R. §438.608(a)(2),(4)) and the Department will take action consistent with 42 C.F.R. §438.610((d). The Contractor shall not certify or pay any excluded provider with Medi-Cal funds, and any such inappropriate payments or overpayments may be subject to recovery and/or be the basis for other sanctions by the appropriate authority.

Excluded Providers. A. The Contractor shall screen and periodically revalidate all network providers in accordance with the requirements of 42 Code of Federal Regulations, part 455, subparts B and E. (42 C.F.R. §438.602(b).) B. Consistent with the requirements of 42 Code of Federal Regulations, part 455.436, the Contractor must confirm the identity and determine the exclusion status of all providers (employees and network providers) and any subcontractor, as well as any person with an ownership or control interest, or who is an agent or managing employee of the of the Mental Health Plan through routine checks of Federal and State databases. This includes the Social Security Administration’s Death Master File, the National Plan and Provider Enumeration System (NPPES), the Office of of‌‌ Inspector General’s List of Excluded Individuals/Entities (LEIE), the System for Award Management (XXX), as well as the Department’s Medi Cal Suspended and Ineligible Provider List (S & I List). (42 C.F.R. C.F.R.‌ §438.602(d).) C. If the Contractor find a party that is excluded, it must promptly notify the Department (42 C.F.R. §438.608(a)(2),(4)) and the Department will take action consistent with 42 C.F.R. §438.610((d). The Contractor shall not certify or pay any excluded provider with Medi-Cal funds, and any such inappropriate payments or overpayments may be subject to recovery and/or be the basis for other sanctions by the appropriate authority.