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 10 contracts
Samples: Preferred Provider Organization Contract, Preferred Provider Organization Contract, Preferred Provider Organization Contract
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 Organization Contract, Preferred Provider Organization Contract
