Provider-Preventable Conditions. A condition that meets the definition of a “health care-acquired condition” or an “other Provider-preventable condition” as defined by 42 C.F.R. § 447.26.
Provider-Preventable Conditions. Pursuant to 42 CFR §438.3(g), the MCO must comply with 42 CFR §447.26 and Minnesota Statutes, §144.7065 (provider-preventable conditions or adverse health care events ) in the encounter data, as determined by the STATE. The STATE shall provide a quarterly report of the MCO’s incidents back to the MCO. In the event that an encounter is reported with any amount other than zero in the payment fields, the MCO shall review and appropriately recoup the payment from the provider, consistent with Minnesota Statutes, §§256.969, subd. 3b, (c) and 256B.0625, subd. 3.
Provider-Preventable Conditions. Provider-preventable condition means a condition occurring in any health care setting that meets the following criteria: (1) is identified in the State plan, (2) has been found by the State, based upon a review of medical literature by qualified professionals, to be reasonably preventable through the application of procedures supported by evidence-based guidelines, (3) has a negative consequence for the beneficiary, (4) is auditable, and (5) includes, at a minimum, wrong surgical or other invasive procedure performed on a patient; surgical or other invasive procedure performed on the wrong body part; surgical or other invasive procedure performed on the wrong patient.
Provider-Preventable Conditions. Contractor shall not pay any provider claims nor reimburse a provider for a Provider-Preventable Condition (PPC), in accordance with 42 CFR 438.3(g). Contractor shall report, and require any and all of its subcontracted providers to report, PPCs in the form and frequency required by APL 17-009.
Provider-Preventable Conditions. Provider shall self-report provider-preventable conditions through Health Plan’s claims system.
Provider-Preventable Conditions a. For Partnership and PACE members, the MCO is prohibited from making payment to a provider for any provider preventable condition as defined in Article I, Definitions.
Provider-Preventable Conditions. The CONTRACTOR shall comply with 42 CFR Part 438 requirements mandating provider identification of provider-preventable conditions as a condition of payment, as well as the prohibition against payment for provider-preventable conditions as set forth in 42 CFR §434.6(a)(12) and § 447.26. The CONTRACTOR shall submit all identified Provider Preventable Conditions in a form or frequency as described by TENNCARE.
Provider-Preventable Conditions a. Contractor is prohibited from making payment to a provider for provider-preventable conditions that are outlined in the Michigan Medicaid State Plan.
Provider-Preventable Conditions. The MCO must comply with any reporting requirements mandated by CMS to document the occurrences of provider-preventable conditions in the Medicaid program. The format and frequency will be specified by BMS.
Provider-Preventable Conditions. The subcontractor must report to the MCO all provider preventable conditions with claims for payment or member treatments for which payment would otherwise be made.
