Requirements for and Limitations for Billing of Claims and Payments of Claims. The PROVIDER shall submit valid claims for PAYOR-authorized services rendered to Medicaid covered or indigent CONSUMERs hereunder. All valid claims of the PROVIDER shall specify billable services hereunder. In order to be considered valid claims for which payments from the PAYOR may be made, the PROVIDER’s billing of a service claim must be received by the PAYOR as outlined in Attachment C – Local Practices & Reporting Requirements following the completion of the period in which the services were rendered hereunder. within: (1.) Ninety (90) days after the actual services were rendered for a PAYOR-authorized CONSUMER whose Medicaid or indigent status has been established without pending third party approval; or, (2.) ninety (90) days after Medicaid or indigent status is no longer pending third party approval for a PAYOR-authorized CONSUMER of services rendered by the PROVIDER. The PAYOR shall authorize and process service claims payments to the PROVIDER within thirty (30)forty-five (45) days following receipt of complete and accurate billing statement from the PROVIDER. The PROVIDER's submittal of valid a billing statement of claims for any service fees hereunder shall constitute PROVIDER's verification that the required services and service documentation have been completed, in compliance with the reimbursement requirements of the PAYOR, the MDHHS, Medicaid, and/or third party reimbursers and is on file currently. If the PROVIDER's services and service documentation are not in compliance with the reimbursement requirements of the MDHHS, the PAYOR, Medicaid, and/or third party reimbursers, the PROVIDER shall not be paid and/or shall return payments received from the PAYOR in such instances. Denial of payment due to non-compliance with claims submission and/or financial requirements may be appealed in accordance with the PAYOR’s provider appeal policy and/or procedure. The PAYOR may request the PROVIDER to submit documentation to receive payments as Electronic Funds Transfers (EFT)/Direct Deposits before payment can be made. The PROVIDER is required to update the PAYOR any time this information has changed. These forms will be provided to the PROVIDER or can be obtained from the PAYOR’s website. Said contract reconciliation shall be completed in full compliance with the Mental Health Code, the MDHHS Rules, the MDHHS/CMHSP Master Contract for General Funds, the MDHHS/PIHP Master Contract for Medicaid Funds and applicable State and federal laws, including Medi...
Requirements for and Limitations for Billing of Claims and Payments of Claims. The PROVIDER shall submit valid claims for PAYOR-authorized services rendered to Medicaid covered or indigent CONSUMERs hereunder. All valid claims of the PROVIDER shall specify billable services hereunder. In order to be considered valid claims for which payments from the PAYOR may be made, the PROVIDER’s billing of a service claim must be received by the PAYOR as outlined in Attachment C – Local Practices & Reporting Requirements following the completion of the period in which the services were rendered hereunder. The PAYOR shall authorize and process service claims payments to the PROVIDER within thirty (30)days following receipt of complete and accurate billing statement from the PROVIDER. The PROVIDER's submittal of valid claims for any service fees hereunder shall constitute PROVIDER's verification that the required services and service documentation have been completed, in compliance with the reimbursement requirements of the PAYOR, the MDHHS, Medicaid, and/or third party reimbursers and is on file currently. If the PROVIDER's services and service documentation are not in compliance with the reimbursement requirements of the MDHHS, the PAYOR, Medicaid, and/or third party reimbursers, the PROVIDER shall not be paid and/or shall return payments received from the PAYOR in such instances.
Requirements for and Limitations for Billing of Claims and Payments of Claims. The PROVIDER shall provide a billing statement with valid claims for PAYOR-authorized services rendered to Medicaid covered or indigent CONSUMERs hereunder. In order to be considered valid claims for which payments from the PAYOR may be made, the PROVIDER’s billing of a service claim must be received by the PAYOR within: (1.) Ninety (90) days after the actual services were rendered for a PAYOR-authorized CONSUMER whose Medicaid or indigent status has been established without pending third party approval; or, (2.) ninety (90) days after Medicaid or indigent status is no longer pending third party approval for a PAYOR-authorized CONSUMER of services rendered by the PROVIDER. The PAYOR’s CEO shall authorize and process service claims payments to the PROVIDER within forty-five (45) days following receipt of complete and accurate billing statement from the PROVIDER.
