Fraud and Abusive Billing. We have processes to review claims before and after payment to detect fraud and abusive billing. Members seeking services from Non-Participating Providers could be balance billed by the Non-Participating Provider for those services that are determined to be not payable as a result of a reasonable belief of fraud or other intentional misconduct or abusive billing.
Appears in 9 contracts
Samples: Preferred Provider, www1.deltadentalins.com, Preferred Provider
Fraud and Abusive Billing. We have processes to review claims before and after payment to detect fraud and abusive billing. Members seeking services from Non-Participating Providers could be balance billed by the Non-Non- Participating Provider for those services that are determined to be not payable as a result of a reasonable belief of fraud or other intentional misconduct or abusive billing.
Appears in 5 contracts
Samples: Preferred Provider Organization Contract, Preferred Provider, Preferred Provider Organization Contract
