PAYMENT FOR COMMUNITY SUPPORTS Clause Samples

PAYMENT FOR COMMUNITY SUPPORTS. 4.1 Provider shall record, generate, and send a claim or invoice to Partnership for Community Supports rendered. a. If Provider submits claims, Provider shall submit claims to Partnership using specifications based on national standards and code sets to be defined by DHCS. DRAFT b. In the event Provider is unable to submit claims to Partnership for Community Supports using specifications based on national standards or DHCS-defined standard specifications and code sets, Provider shall submit invoices with an excel spreadsheet with the minimum necessary data elements defined by DHCS, or as defined in Partnership Policy which includes information about the Member, the Community Supports rendered, and Provider’s information to support appropriate reimbursement by Partnership that will allow Partnership to convert Community Supports invoice information into DHCS- defined standard specifications and code sets for submission to DHCS. Upon receipt of such an invoice, Partnership shall document the Encounter for the Community Supports rendered. c. Provider will submit complete, timely, reasonable, and accurate claims or invoices, Provider Data, Encounter Data, and any other reports and data that Partnership might need, according to all Applicable Requirements for all Services rendered to Medi-Cal Members as described in Partnership’s Provider Manual. d. All claims or invoices for reimbursement of Services must be submitted to Partnership as soon as possible, but no later than within three hundred and sixty-five (365) days from the date of Services. Claims or invoices received on the 366th day form the date of service will be denied. Partnership will make no exceptions or pro-rated payments beyond the twelve (12) month billing limit. 4.2 Provider shall not receive payment from Partnership for the provision of any Community Supports not authorized by Partnership. 4.3 Provider must have a system in place to accept payment from Partnership for Community Supports rendered. a. Partnership shall pay 90 percent of all Clean Claims and invoices within 30 calendar days of receipt and 99 percent of Clean Claims and invoices within 90 calendar days of receipt. The date of receipt shall be the date Partnership receives the claim, as indicated by its date stamp on the claim. The date of payment shall be the date on the check or other form of payment. b. Partnership shall provide expedited payments for Urgent Community Supports pursuant to its policies and procedures, Medi-Cal Co...