Common use of Requirements for and Limitations for Billing of Claims and Payments of Clean Claims Clause in Contracts

Requirements for and Limitations for Billing of Claims and Payments of Clean Claims. The PROVIDER shall submit a periodic billing statement with valid claims for each period in which PAYOR- authorized services are rendered under this Agreement. All periodic billing statements 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 service claims 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 a 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 Clean Claims. The PROVIDER shall submit a periodic billing statement with valid claims for each period in which PAYOR- PAYOR-authorized services are rendered under this Agreement. All periodic billing statements 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 service claims 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 a 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.