Common use of Timely Payment Requirement Clause in Contracts

Timely Payment Requirement. The MCO must agree to make timely claims payments to both its contracted and non-contracted providers. A claim is defined as a bill for services, a line item of service, or all services for one (1) enrollee within a bill. A clean claim is defined as one that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. The MCO must pay all clean electronic and paper claims for covered services from both in- network and out-of-network providers within thirty (30) calendar days of receipt, except to the extent the provider has agreed to later payment in writing. The MCO must agree to specify the date of receipt as the date the MCO receives the claim, as indicated by its date stamp (including electronic date stamp) on the claim, and date of payment as the date of the check release or other form of payment release to the provider. The MCO must submit monthly a claim aging report that provides information on all overdue clean claims for both in-network and out-of-network providers as noted in Appendix D. The MCO must pay both in-network and out-of-network providers interest at eighteen percent (18%) per annum, calculated daily for the full period in which the clean claim remains unpaid beyond the thirty (30) day clean claims payment deadline. Interest owed to the provider must be paid on the same date as the claim. The interest paid to the providers will not be reported as a part of the MCO encounter data. This provision does not apply to payments made due to a rate change per Article III, Section 2.7.9. As related to the sanction outlined in Appendix F, the MCO must meet a ninety percent (90%) threshold for timely claims payment (90% of total clean claims within 30 days), which aligns with 42 CFR §447.45(d)(2) for fee-for-service Medicaid.

Timely Payment Requirement. The MCO must agree to make timely claims payments to both its contracted and non-contracted providers. A claim is defined as a bill for services, a line item of service, or all services for one (1) enrollee within a bill. A clean claim is defined as one that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. The MCO must pay all clean electronic and paper claims for covered services from both in- network and out-of-network providers within thirty (30) calendar days of receipt, except to the extent the provider has agreed to later payment in writing. The MCO must agree to specify the date of receipt as the date the MCO receives the claim, as indicated by its date stamp (including electronic date stamp) on the claim, and date of payment as the date of the check release or other form of payment release to the provider. The MCO must submit monthly a claim claims aging report that provides information on all overdue clean claims for both in-network and out-of-network providers as noted in Appendix D. E. The MCO must pay both in-network and out-of-network providers interest at eighteen percent (18%) per annum, calculated daily for the full period in which the clean claim remains unpaid beyond the thirty (30) day clean claims payment deadline. Interest owed to the provider must be paid on the same date as the claim. The interest paid to the providers will not be reported as a part of the MCO encounter data. This provision does not apply to payments made due to a rate change per Article III, Section 2.7.9. As related to the sanction outlined in Appendix FG, the MCO must meet a ninety percent (90%) threshold for timely claims payment (90% of total clean claims within 30 days), which aligns with 42 CFR §447.45(d)(2) 447.45 for fee-for-service Medicaid.

Timely Payment Requirement. The MCO must agree to make timely claims payments to both its contracted and non-contracted providers. A claim is defined as a bill for services, a line item of service, or all services for one (1) enrollee within a bill. A clean claim is defined as one that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. The MCO must pay all clean electronic and paper claims for covered services from both in- network and out-of-network providers within thirty (30) calendar days of receipt, except to the extent the provider has agreed to later payment in writing. The MCO must agree to specify the date of receipt as the date the MCO receives the claim, as indicated by its date stamp (including electronic date stamp) on the claim, and date of payment as the date of the check release or other form of payment release to the provider. The MCO must submit monthly a claim aging report that provides information on all overdue clean claims for both in-network and out-of-network providers as noted in Appendix D. The MCO must pay both in-network and out-of-network providers interest at eighteen percent (18%) per annum, calculated daily for the full period in which the clean claim remains unpaid beyond the thirty (30) day clean claims payment deadline. Interest owed to the provider must be paid on the same date as the claim. The interest paid to the providers will not be reported as a part of the MCO encounter data. This provision does not apply to payments made due to a rate change per Article III, Section 2.7.9. As related to the sanction outlined in Appendix F, the MCO must meet a ninety percent (90%) threshold for timely claims payment (90% of total clean claims within 30 days), which aligns with 42 CFR §447.45(d)(2) 447.45 for fee-for-service Medicaid.

Timely Payment Requirement. The MCO must agree to make timely claims payments to both its contracted and non-contracted providers. A claim is defined as a bill for services, a line item of service, or all services for one (1) enrollee within a bill. A clean claim is defined as one that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. The MCO must pay all clean electronic and paper claims for covered services from both in- network and out-of-network providers within thirty (30) calendar days of receipt, except to the extent the provider has agreed to later payment in writing. The MCO must agree to specify the date of receipt as the date the MCO receives the claim, as indicated by its date stamp (including electronic date stamp) on the claim, and date of payment as the date of the check release or other form of payment release to the provider. The MCO must submit monthly a claim claims aging report that provides information on all overdue clean claims for both in-network and out-of-network providers as noted in Appendix D. The MCO must pay both in-network and out-of-network providers interest at eighteen percent (18%) per annum, calculated daily for the full period in which the clean claim remains unpaid beyond the thirty (30) day clean claims payment deadline. Interest owed to the provider must be paid on the same date as the claim. The interest paid to the providers will not be reported as a part of the MCO encounter data. This provision does not apply to payments made due to a rate change per Article III, Section 2.7.9. As related to the sanction outlined in Appendix F, the MCO must meet a ninety percent (90%) threshold for timely claims payment (90% of total clean claims within 30 days), which aligns with 42 CFR §447.45(d)(2) 447.45 for fee-for-service Medicaid.