Timely Provider Payments. 1. The Contractor must make timely payments to its providers. The Contractor must ensure that 90% of payment claims from physicians who are in individual or group practice, which can be processed without obtaining additional information from the physician or from a third party, will be paid within 30 days of the date of receipt of the claim. In addition, 99% of all claims from Covered Service providers will be paid within 90 days from the date the Contractor receives the claim. The Contractor and its providers may by mutual agreement, in writing, establish an alternative payment schedule. Generally, the date receipt is the date the agency receives the claim, as indicated by its date stamp on the claim. The date of payment is the date of the check or other form of payment.
2. Submit a claims processing annual report on timely payment to providers.
Timely Provider Payments. The Contractor must make timely payments to Providers. The Contractor must ensure that ninety percent (90%) of payment claims from physicians who are in individual or group practice, which can be processed without obtaining additional information from the physician or from a Third Party (hereinafter “Clean Claim”), from Providers for Covered Services will be paid within thirty (30) days after the date of receipt of the claim. The Contractor must ensure that ninety-nine percent (99%) of Clean Claims from Providers for Covered Services will be paid within ninety (90) days after the date of receipt of the claim. The Contractor and its Providers may by mutual agreement, in writing, establish an alternative payment schedule provided that payment is no less timely than provided in this Section 5.1.9.
5.1.9.1 The Contractor shall pay for family planning services, subject to Appendix A, Section A.5 hereof, rendered by a non-Affiliated Provider, for which the Contractor would pay if rendered by an Affiliated Provider, at the same rate the Department would pay for such services exclusive of disproportionate share payments and Medicaid percentage adjustments, unless a different rate was agreed upon by Contractor and the non-Affiliated Provider.
5.1.9.2 The Contractor shall accept claims for non-Affiliated Providers for at least one hundred eighty (180) days after the date the services are provided. The Contractor shall not be required to pay for claims initially submitted by such non-Affiliated Providers more than one hundred eighty (180) days after the date of service.
Timely Provider Payments. The ICO must make timely payments to its providers, including Indian Health Care Providers. The ICO must include a prompt payment provision in its contracts with providers, including Indian Health Care Providers and suppliers, the terms of which are developed and agreed to by both the ICO and the relevant provider. The ICO must ensure that ninety percent (90%) of payment Claims, which can be processed without obtaining additional information from the physician or from a third party ( a “Clean Claim”), from physicians who are in individual or group practice will be paid within ninety (90) calendar days of the date of receipt of the Claim. Claims from LTSS providers will be paid within thirty (30) calendar days of the date of receipt of the “clean Claim” or other form of itemized Claim including a paper or electronic invoice or receipt for services or a service/work log. The ICO and its providers, including Indian Health Care Providers, may by mutual agreement, in writing, establish an alternative payment schedule. The ICO must make timely payments to all providers for covered services rendered to Enrollees as required by MCL 400.111i and in compliance with any established MDHHS performance standards. The ICO is not responsible for any payments owed to providers for services rendered prior to a Potential Enrollee's Enrollment with the ICO’s plan. Payment for services provided during a period of retroactive Medicaid eligibility will be the responsibility of MDHHS unless the services were delivered during an active MI Health Link deeming period. The ICO is responsible for annual IRS form 1099, Reporting of Provider Earnings, and must make all collected data available to MDHHS and, upon request, to CMS. Total Payment: The ICO or its providers may not require any co-payments or other cost-sharing arrangements. The ICO providers must not bill Enrollees for the difference between the provider’s charge and the ICO’s payment for Covered Services. The ICO’s providers must not seek nor accept additional or supplemental payment from the Enrollee, their family, or representative, in addition to the amount paid by the ICO even when the Enrollee signed an agreement to do so. These provisions also apply to out-of-network providers. Protection of Enrollee-Provider Communications In accordance with 42 USC §1396 u-2(b)(3), the ICO shall not prohibit or otherwise restrict a provider or clinical First Tier, Downstream, or Related Entity of the ICO from advi...
Timely Provider Payments. The plan shall comply with the provider payment provisions pursuant to this contract.
Timely Provider Payments. 5.1.9.1. The Contractor must make timely payments to its providers. The Contractor must ensure that ninety percent (90%) of claims from physicians who are in individual or group practice, which can be processed without obtaining additional information from the physician or from a third party, will be paid within thirty (30) days of the date of receipt of the claim. In addition, ninety-nine percent (99%) of all clean claims from Covered Service providers will be paid within ninety (90) days of the date of receipt of the claim. The Contractor and its providers may by mutual agreement, in writing, establish an alternative payment schedule. Generally, the date of receipt is the date the agency receives the claim, as indicated by its date stamp on the claim. The date of payment is the date of the check or other form of payment.
5.1.9.1.1. Clean claims include claims with errors originating from the Contractor’s claims systems but does not include claims from a provider who is under investigation for fraud or abuse, nor claims under review for Medical Necessity.
5.1.9.1.2. Interest charges shall be paid for Medicaid claims in accordance with 2.10.1.5.
5.1.9.1.3. Pharmacy providers will be reimbursed in accordance with the prompt payment provisions at 42 CFR § 423. 505(i)(3)(vi).
