Common use of UNDERPAYMENT/PAYMENTS POST APPEALS Clause in Contracts

UNDERPAYMENT/PAYMENTS POST APPEALS. a. If the LME/PIHP determines that CONTRACTOR has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) days notice to the CONTRACTOR of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the CONTRACTOR. CONTRACTOR shall have thirty (30) days from date of such notification to appeal the determination of the LME/PIHP. The LME/PIHP shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims. b. Within thirty (30) days of the conclusion of any grievance, appeal or litigation that determines that LME/PIHP improperly failed to pay a claim or a portion of a claim to CONTRACTOR, the LME/PIHP shall remit the amount determined to be owed to CONTRACTOR.

UNDERPAYMENT/PAYMENTS POST APPEALS. a. If the LME/PIHP determines that CONTRACTOR LIP has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) days days’ notice to the CONTRACTOR LIP of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the CONTRACTORLIP. CONTRACTOR LIP shall have thirty (30) days from date of such notification to appeal the determination of the LME/PIHP. The LME/PIHP shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims. b. Within thirty (30) days of the conclusion of any grievance, appeal or litigation that determines that LME/PIHP improperly failed to pay a claim or a portion of a claim to CONTRACTORLIP, the LME/PIHP shall remit the amount determined to be owed to CONTRACTORLIP.

UNDERPAYMENT/PAYMENTS POST APPEALS. a. If the LME/PIHP determines that CONTRACTOR Contractor has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) days notice to the CONTRACTOR Contractor of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the CONTRACTORContractor. CONTRACTOR Contractor shall have thirty (30) days from date of such notification to appeal the determination of the LME/PIHP. The LME/PIHP shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims. b. Within thirty (30) days of the conclusion of any grievance, appeal or litigation that determines that LME/PIHP improperly failed to pay a claim or a portion of a claim to CONTRACTORContractor, the LME/PIHP shall remit the amount determined to be owed to CONTRACTOR.Contractor. (Remainder of page left intentionally blank)

UNDERPAYMENT/PAYMENTS POST APPEALS. a. If the LME/PIHP determines that CONTRACTOR has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) days notice to the CONTRACTOR of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the CONTRACTOR. CONTRACTOR shall have thirty (30) days from date of such notification to appeal the determination of the LME/PIHP. The LME/PIHP shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims. b. Within thirty (30) days of the conclusion of any grievance, appeal or litigation that determines that LME/PIHP improperly failed to pay a claim or a portion of a claim to CONTRACTOR, the LME/PIHP shall remit the amount determined to be owed to CONTRACTOR.. <<PROVIDER NAME>>