Post-payment Review Sample Clauses

Post-payment Review. The CMHSP may utilize a post-payment review methodology to assure claims have been paid appropriately.
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Post-payment Review. The PIHP may utilize a post-payment review methodology to assure claims have been paid appropriately. Regardless of method, the PIHP must have a process in place to verify that services were actually provided.
Post-payment Review. The INSURER will establish a program to review service claims for purposes of creating a provider profiling system. The INSURER shall submit a report to the ADMINISTRATION on a quarterly basis of all findings under the Utilization Review Programs. The ADMINISTRATION may review and/or audit the programs' findings and reports at any time.
Post-payment Review. The Provider shall provide any relevant information requested by CMHSP to conduct post-payment review of claims. If services or documentation are identified that are not in compliance with the requirements of CMHSP, the PIHP, the MDHHS, Medicaid, Medicare, and/or third-party payors, payback of funds may be required.
Post-payment Review a. Contractor must utilize a post-payment review methodology to assure claims have been paid appropriately. b. Contractor must complete post-payment reviews for individuals retroactively disenrolled by MDHHS within 90 days of the date MDHHS notifies the Contractor of the retroactive disenrollment. c. Contractor must complete the recoupments from Providers within 90 days of identifying the claims to be recouped. d. Contractor must not recoup money from Providers for individuals retroactively disenrolled by MDHHS more than 180 days from the date that MDHHS notified the Contractor of the retroactive disenrollment. J. Automated Contact Tracking System Contractor must utilize the MDHHS Automated Contact Tracking System to submit the following requests: 1. Disenrollment requests for out of area Enrollees who appear in the wrong county on the Contractor’s enrollment file (as applicable). 2. Other administrative requests specified by MDHHS. K. Provider File 1. Provider files are used by the Enrollment Broker to convey information to beneficiaries on available contractors and network providers for each Contractor. 2. MDHHS utilizes the provider file to ensure the provider networks identified for Contractors are adequate in terms of number, location, and hours of operation. 3. Contractor must submit provider files that contain a complete and accurate description of the provider network available to Enrollees according to the specifications and format delineated by MDHHS to the MDHHS enrollment services contractor. 4. The Provider file must contain all network providers. 5. The Contractor must specifically identify any providers that are IHCPs. 6. Contractor must submit a provider file that passes all MDHHS quality edits to the MDHHS enrollment services contractor at least once per month, and more frequently if necessary, to ensure changes in the Contractor’s provider network are reflected in the provider file as required in this Contract.
Post-payment Review a. Contractor must utilize a post-payment review methodology to assure claims have been paid appropriately. b. Contractor must complete post-payment reviews for individuals retroactively disenrolled by MDHHS for incarceration within 90 days of the date MDHHS notifies the Contractor of the retroactive disenrollment. This disenrollment is identified with a disenrollment reason code of I on the 5629 834 daily enrollment file. c. Contractor must not recoup money from Providers for individuals retroactively disenrolled for incarceration by MDHHS more than 180 days from the date that MDHHS notified the Contractor of the retroactive disenrollment. d. Contractor must complete post-payment reviews for individuals disenrolled by MDHHS due to death within 90 Days of the date MDHHS notifies the Contractor of the Enrollee’s death or within 90 Days of the date MDHHS notifies the Contractor of disenrollment from the plan (if disenrollment notification is after notification of death). Disenrollments due to Death are identified with disenrollment reason code D on the 5629 834 daily enrollment file. e. Effective April 1, 2023, for retroactive disenrollments due to loss of eligibility or other unspecified reason, the Contractor must not automatically recoup payments made to providers; these disenrollments are identified with disenrollment reason code L and O, respectively, on the 5629 834 daily enrollment file. Recoupment of the capitation from the Contractor is based on several eligibility and enrollment factors that may change after the Enrollee is disenrolled. Contractors may not recoup from providers unless MDHHS recoups the capitation payment from the Contractor and does not reimburse the Contractor for the recouped capitation amount. i. If the Enrollee is retroactively disenrolled due to loss of Medicaid eligibility and regains Medicaid eligibility within two months, the Enrollee will be retroactively reenrolled to the same Contractor (See Section V.C.2). MDHHS will not recoup the capitation payment from the provider for the retroactive time period and the Contractor is prohibited from recouping payments from providers. ii. If an Enrollee is retroactively disenrolled due to retroactive loss of eligibility in error, when the eligibility is corrected, MDHHS will send a replacement enrollment to the Contractor when the eligibility is corrected (See Section V.G.3). MDHHS will not recoup the capitation payment from the provider for the retroactive time period and the Contra...
Post-payment Review. The Contractor shall provide any relevant information requested by CMH to conduct post‐payment review of claims. If services or documentation are identified that are not in compliance with the requirements of CMH, the Lakeshore Regional Entity (PIHP), the MDHHS/MDCH, Medicaid, Medicare, and/or third party payors, payback of funds may be required.
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Related to Post-payment Review

  • Post Review With respect to each contract not governed by paragraph 2 of this Part, the procedures set forth in paragraph 4 of Appendix 1 to the Guidelines shall apply.

  • Interest Payment Frequency   Interest Payment Dates Monthly Fifteenth day of each calendar month, beginning in the first calendar month following the month this Note was issued. Quarterly Fifteenth day of every third calendar month, beginning in the third calendar month following the month this Note was issued. Semi-annual Fifteenth day of every sixth calendar month, beginning in the sixth calendar month following the month this Note was issued. Annual Fifteenth day of every twelfth calendar month, beginning in the twelfth calendar month following the month this Note was issued.

  • First Payment As of the Cut-off Date, the related Obligor has made the initial payment on such Receivable. Servicing System Records/Data File i) Review servicing system records and confirm that the Obligor has made at least one payment on the Receivable. ii) If confirmed, then Test Pass

  • Deferrals of Interest Payment Dates (a) So long as no Event of Default has occurred and is continuing, the Company shall have the right, at any time and from time to time during the term of the Security, to defer the payment of interest on the Securities for a period of up to twenty (20) consecutive quarterly interest payment periods (each such period, an “Extension Period”), during which Extension Period(s), the Company shall have the right to make no payments or partial payments of interest on any Interest Payment Date (except any Additional Tax Sums that otherwise may be due and payable). No Extension Period shall end on a date other than an Interest Payment Date and no Extension Period shall extend beyond the Stated Maturity of the principal of the Securities. No interest shall be due and payable during an Extension Period, except at the end thereof, but each installment of interest that would otherwise have been due and payable during such Extension Period shall bear Additional Interest (to the extent payment of such interest would be legally enforceable) at a variable rate per annum, reset quarterly, equal to LIBOR plus 2.65%, compounded quarterly, from the dates on which amounts would have otherwise been due and payable until paid or until funds for the payment thereof have been made available for payment. At the end of any such Extension Period, the Company shall pay all interest then accrued and unpaid on the Securities together with such Additional Interest. Prior to the termination of any such Extension Period, the Company may extend such Extension Period and further defer the payment of interest; provided, that (i) all such previous and further extensions comprising such Extension Period do not exceed twenty (20) quarterly interest payment periods, (ii) no Extension Period shall end on a date other than an Interest Payment Date and (iii) no Extension Period shall extend beyond the Stated Maturity of the principal of the Securities. Upon the termination of any such Extension Period and upon the payment of all accrued and unpaid interest and any Additional Interest then due on any Interest Payment Date, the Company may elect to begin a new Extension Period; provided, that (i) such Extension Period does not exceed twenty (20) quarterly interest payment periods, (ii) no Extension Period shall end on a date other than an Interest Payment Date and (iii) no Extension Period shall extend beyond the Stated Maturity of the principal of the Securities. The Company shall give the Holders of the Securities and the Trustee written notice of its election to begin any such Extension Period at least one Business Day prior to the next succeeding Interest Payment Date on which interest on the Securities would be payable but for such deferral or, so long as any Securities are held by the Trust, at least one Business Day prior to the earlier of (i) the next succeeding date on which Distributions on the Preferred Securities of such Trust would be payable but for such deferral and (ii) the date on which the Property Trustee of such Trust is required to give notice to any securities exchange or other applicable self-regulatory organization or to holders of such Preferred Securities of the record date for the payment of such Distributions. (b) In connection with any such Extension Period, the Company shall be subject to the restrictions set forth in Section 10.6(a).

  • Interest Payment and Computation Interest on each Base Rate Loan shall be due and payable in arrears on the last Business Day of each calendar quarter commencing December 31, 2011; and interest on each LIBOR Rate Loan shall be due and payable on the last day of each Interest Period applicable thereto, and if such Interest Period extends over three (3) months, at the end of each three (3) month interval during such Interest Period. All computations of interest for Base Rate Loans when the Base Rate is determined by the Prime Rate shall be made on the basis of a year of 365 or 366 days, as the case may be, and actual days elapsed. All other computations of fees and interest provided hereunder shall be made on the basis of a 360-day year and actual days elapsed (which results in more fees or interest, as applicable, being paid than if computed on the basis of a 365/366-day year).

  • Interest Payment Date 4 Maturity..................................... 4

  • Interest Payment Dates Accrued interest on each Loan shall be payable in arrears on each Interest Payment Date for such Loan and on the Termination Date; provided that (i) interest accrued pursuant to Section 3.02(c) shall be payable on demand, (ii) in the event of any repayment or prepayment of any Loan (other than an optional prepayment of an ABR Loan prior to the Termination Date), accrued interest on the principal amount repaid or prepaid shall be payable on the date of such repayment or prepayment, and (iii) in the event of any conversion of any Eurodollar Loan prior to the end of the current Interest Period therefor, accrued interest on such Loan shall be payable on the effective date of such conversion.

  • Agreement Review If, pursuant to section 25.10 (Review of Agreement) of the Bilateral Agreement, the Bilateral Agreement is reviewed after three or five years, or both, of the effective date of the Bilateral Agreement, and any changes to the Bilateral Agreement are required as a result, the Parties agree to amend the Agreement as necessary and in a manner that is consistent with such changes.

  • Contract Review Agent shall have reviewed all material contracts of Borrowers including, without limitation, leases, union contracts, labor contracts, vendor supply contracts, license agreements and distributorship agreements and such contracts and agreements shall be satisfactory in all respects to Agent;

  • Interest Payment For each Interest Payment Date the amount of interest due with respect to the Class A(2019-2) Notes shall be an amount equal to (i) (A) a fraction, the numerator of which is the actual number of days in the related Interest Accrual Period and the denominator of which is 360, times

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