Prepayment Review definition

Prepayment Review means a specific review of identified Claims or services or types of Claims or services prior to determination and payment in order to prevent improper payments due to a sustained or high level of payment error or resulting from an analysis that identifies a problem related to possible Fraud, Waste, and/or Abuse.

Prepayment Review or "PPR" means a departmental review of a claim regarding a recipient who is not enrolled with a managed care organization to determine if the requirements of this administrative regulation have been met prior to authorizing payment.

Prepayment Review means any action by the health plan, contracting entity,

Examples of Prepayment Review in a sentence

• Prepayment Review – Prepayment review is performed after the service or item is provided, but prior to payment being issued.

• Prepayment Review This sanction will be imposed for providers who have deficiencies with completing required documentation to support the claim(s) filed to SCDHHS.

• Limits means any of the Prepayment Percentage; the Debt Turn Target; Funding Limits; Funding Period; the Prepayment Review Level; and the Concentration Limit[19 and each a Limit].

• Limits means any of the Prepayment Percentage; the Debt Turn Target; Funding Limits; Funding Period; the Prepayment Review Level; and the Concentration Limit[20 and each a Limit].

• Contract amount includes room rate, RESIDENT selected dining plan (board), and association dues.

• Providers selected for prepayment review will be required to submit SECTION 2 POLICIES AND PROCEDURES PROGRAM SERVICES Prepayment Review (Cont’d.) Administrative Fines, Recoupment, Withholding and/or Offsetting Referral to Licensing Entities and/or SCDHHS Division of Program Integrity documentation to support claims submitted.

• Prepayment Review Request Form Must be approved by MDHHS OIG prior to implementing any prepayment review.