Common use of Rejecting claims Clause in Contracts

Rejecting claims. Rejecting claims (1) The DHB may reject all or part of a claim if it believes on reasonable grounds that the Provider has submitted incomplete or inaccurate information, or has not complied with claiming restrictions or requirements. (2) If the claim was submitted by the Due Date, the DHB will notify the Provider that its claim or a part of its claim has been rejected and the reason for the rejection before the next Claim Period. (3) The Provider may correct and resubmit a claim or part of a claim. (4) If a resubmission results in the Provider owing money to the DHB, the DHB may recover that money in accordance with clause D.43. (5) If the Provider corrects and resubmits a claim: (a) before the Final Due Date, it will be paid in accordance with clause D.39; (b) after the Final Due Date, the claim will be treated as a late claim under clauses D.26 to D.28 and, if applicable, will be paid in accordance with clause D.40. (6) An adjustment amount may be paid under this Agreement from time to time, being an amount agreed between the Provider and the Payment Agent or determined by the DHB, that is to be recovered in respect of an overpayment or reimbursed in respect of an underpayment.

Rejecting claims. Rejecting claims (1) The DHB may reject all or part of a claim if it believes on reasonable grounds that the Provider has submitted incomplete or inaccurate information, or has not complied with claiming restrictions or requirements. (2) If the claim was submitted by the Due Date, the DHB will notify the Provider that its claim or a part of its claim has been rejected and the reason for the rejection before the next Claim Period. (3) The Provider may correct and resubmit a claim or part of a claim. (4) If a resubmission results in the Provider owing money to the DHB, the DHB may recover that money in accordance with clause D.43D.47. (5) If the Provider corrects and resubmits a claim: (a) before the Final Due Date, it will be paid in accordance with clause D.39D.37; (b) after the Final Due Date, the claim will be treated as a late claim under clauses D.26 to D.28 and, if applicable, will be paid in accordance with clause D.40D.38. (6) An adjustment amount may be paid under this Agreement from time to time, being an amount agreed between the Provider and the Payment Agent or determined by the DHB, that is to be recovered in respect of an overpayment or reimbursed in respect of an underpayment.