Common use of Provider Claim Dispute Resolution Tracking and Reporting Clause in Contracts

Provider Claim Dispute Resolution Tracking and Reporting. The MCO must develop and use a system to capture, track, and report the status and resolution of all provider claim disputes, including all associated documentation. The MCO must provide ODM view-only access to its provider claim dispute tracking system. The MCO must evaluate the effectiveness of the claim dispute resolution system and identify opportunities to improve the provider experience. The MCO must use information collected from the claim dispute process to determine if there are claims payment systemic errors (CPSEs) and if improvements are needed to any of their processes. The MCO must submit the Provider Claims Dispute Report to ODM as specified in Appendix P, Chart of Deliverables, including but not limited to information regarding number and types of disputes by provider type, resolution time, identified trends, and program improvements.

Provider Claim Dispute Resolution Tracking and Reporting. 1. The MCO must develop and use a system to capture, track, and report the status and resolution of all provider claim disputes, including all associated documentation. The MCO must provide ODM view-only access to its provider claim dispute tracking system. 2. The MCO must evaluate the effectiveness of the claim dispute resolution system and identify opportunities to improve the provider experience. 3. The MCO must use information collected from the claim dispute process to determine if there are claims payment systemic errors (CPSEs) and if improvements are needed to any of their processes. 4. The MCO must submit the Provider Claims Dispute Report to ODM as specified in Appendix P, Chart of Deliverables, including but not limited to information regarding number and types of disputes by provider type, resolution time, identified trends, and program improvements.