Common use of Two Year Limit to Assert Claim Clause in Contracts

Two Year Limit to Assert Claim. (1) The STATE shall not assert any claim for, seek the reimbursement of, or make any adjustment for any alleged overpayment made by the STATE to the MCO under section 4.1 of this Contract more than two (2) years after the date such payment was actually received by the MCO from the STATE. This two year limitation does not apply to duplicate payments made because of multiple identification numbers for the same Enrollee, payments for full months for an Enrollee while Incarcerated, payments for full months after the death of the Enrollee, and in the event that CMS or the state or federal Office of the Inspector General requires the STATE to recover payments. (2) The MCO shall not assert any claim for, seek the payment of, or make any adjustment for any alleged underpayment made by the STATE to the MCO under Article 4 of this Contract more than two (2) years after the date such payment was actually received by the MCO from the STATE. The MCO must have filed a timely appeal of risk factors under section 4.13 in order to assert any claims regarding risk adjusted payments.

Two Year Limit to Assert Claim. (1) The STATE shall not assert any claim for, seek the reimbursement of, or make any adjustment for any alleged overpayment made by the STATE to the MCO under section 4.1 of this Contract more than two (2) years after the date such payment was actually received by the MCO from the STATE. This two year limitation does not apply to duplicate payments made because of multiple identification numbers for the same Enrollee, payments for full months for an Enrollee while Incarcerated, payments for full months after the death of the Enrollee, and in the event that CMS or the state or federal Office of the Inspector General requires the STATE to recover payments. (2) The MCO shall not assert any claim for, seek the payment reimbursement of, or make any adjustment for any alleged underpayment made by the STATE to the MCO under Article 4 of this Contract more than two (2) years after the date such payment was actually received by the MCO from the STATE. The MCO must have filed a timely appeal of risk factors under section 4.13 in order to assert any claims regarding risk adjusted payments.