Fraud, Waste, and Abuse. Provider understands and agrees that each claim the Provider submits to Subcontractor constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State or Subcontractor provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor upon its request in order to determine appropriateness of coding. Further, when Provider t has received an overpayment, Provider will return the overpayment to Subcontractor within 60 calendar days after the date on which the overpayment was identified, and to notify Subcontractor in writing of the reason for the overpayment.
Appears in 3 contracts
Samples: Ohio Medicaid and Chip Regulatory Requirements Appendix, Provider Agreement, Ohio Medicaid and Chip Regulatory Requirements Appendix
Fraud, Waste, and Abuse. Provider understands and agrees that each claim the Provider submits to Subcontractor United constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State or Subcontractor United provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor United performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor United upon its request in order to determine appropriateness of coding. Further, when Provider t has received an overpayment, Provider will return the overpayment to Subcontractor United within 60 calendar days after the date on which the overpayment was identified, and to notify Subcontractor United in writing of the reason for the overpayment.
Appears in 3 contracts
Samples: Medicaid and Chip Regulatory Requirements Appendix, Medicaid and Chip Regulatory Requirements Appendix, Colorado Medicaid and Chip Regulatory Requirements Appendix
Fraud, Waste, and Abuse. Provider understands and agrees that each claim the Provider submits to Subcontractor United constitutes a certification that the Provider has complied with all applicable Medicaid laws, regulations and program instructions in connection with such claims and the services provided therein. Provider’s payment of a claim will be denied if Provider is terminated or excluded from participation in federal healthcare programs. Provider’s payment of a claim may be temporarily suspended if the State or Subcontractor United provides notice that a credible allegation of fraud exists and there is a pending investigation. Provider’s payment of a claim may also be temporarily suspended or adjusted if the Provider bills a claim with a code that does not match the service provided. Subcontractor United performs coding edit procedures based primarily on National Correct Coding Initiative (NCCI) policies and other nationally recognized and validated policies. Provider agrees that it will provide medical records to Subcontractor United upon its request in order to determine appropriateness of coding. Further, when Provider t has received an overpayment, Provider will return the overpayment to Subcontractor United within 60 calendar days after the date on which the overpayment was identified, and to notify Subcontractor United in writing of the reason for the overpayment.
Appears in 1 contract
Samples: Provider Agreement
