Denial of payment definition

Denial of payment means that the department has denied payment for a medical assistance claim or reduced the level of service payment for a service provided to an individual who was an eligible medical assistance recipient at the time the service was provided or the recoupment or adjustment of a claim, or part of a claim, following an audit or review.

Denial of payment means that the department has denied payment for a medical assistance claim or reduced the level of service payment for a service provided to an individual who was an eligible medical assistance recipient at the time the service was provided.

Examples of Denial of payment in a sentence

• If a facility does not meet the criteria for continuation of payment under subrule 81.37(1), the facility’s provider agreement shall be terminated.81.37(3) Denial of payment.

• If an acceptable ePoC is not received within 10 calendar days from the receipt of this letter, we will recommend to the CMS Region V Office that one or more of the following remedies be imposed: • Denial of payment for new Medicare and Medicaid admissions (42 CFR 488.417); • Civil money penalty (42 CFR 488.430 through 488.444).

• Denial of payment for procedures performed without prior authorization.

• Denial of payment of health care services provided pursuant to the Act, whether in whole or in part, shall be accompanied with written explanation for reason for denial.

• Denial of payment by the state agency or payment of a claim by the vendor for a vendor violation(s) shall not absolve the vendor of the violation(s).

• The alter- native sanctions that CMS may apply in the circumstances specified in para- graph (a) of this section include the fol- lowing:(1) Denial of payment for services furnished to patients first accepted for care after the effective date of the sanction as specified in the sanction notice.(2) Reduction of payments, for all ESRD services furnished by the sup- plier, by 20 percent for each 30-day pe- riod after the effective date of the sanction.

• Denial of payment for any Service(s) rendered by Provider arising from this Contract must be appealed to HCJFS within sixty (60) business days from receipt of the payment denial.

• Denial of payment by the State WIC Agency or payment of a claim by the vendor for a vendor violation(s) shall not absolve the vendor of the violation(s).

• Denial of payment for procedures on the Inpatient Only List is appealable under the Appeal of Factual (Non-Medical Necessity) Determinations.

• Denial of payment for any new admis- sion to a skilled nursing facility (SNF), inter- mediate care facility (ICF) or ICF/mentally retarded (MR) that no longer meets the appli- cable conditions of participation (for SNFs) or standards (for ICFs and ICF/MRs) if the facility’s deficiencies do not pose immediate jeopardy to patients’ health and safety.