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.
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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.
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Prepayment Review means any action by the health plan, contracting entity,
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Examples of Prepayment Review in a sentence

  • State Laws that Affect Prepayment Review Timeliness Requirements The MACs shall adhere to state laws that require an evidentiary hearing for the beneficiary before any denials are processed.

  • Prepayment Review Requirements for MACs When a MAC receives requested documentation for prepayment review within 45 calendar days of the date of the ADR, the MAC shall do the following within 30 calendar days of receiving the requested documentation: 1) make and document the review determination and 2) enter the decision into the Fiscal Intermediary Shared System (FISS), Multi-Carrier System (MCS), or the VIPS Medicare System (VMS).

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

  • Prepayment Review Requirements for UPICs When a UPIC receives all documentation requested for prepayment review within 45 calendar days of the date of the ADR, the UPIC shall make and document the review determination and notify the MAC of its determination within 60 calendar days of receiving all requested documentation.

  • Limits on Automated Prepayment Review The MACs shall not install edits that result in the automatic denial of payment for items or services based solely on the diagnosis of a progressively debilitating disease when treatment may be reasonable and necessary.

  • The MassHealth agency pays for procedures and acute hospital stays that are subject to the acute hospital Utilization Management Program only if the applicable requirements of the program as described in 130 CMR 450.207: Utilization Management Program for Acute Inpatient Hospitals through 450.209: Utilization Management: Prepayment Review for Acute Inpatient Hospitals are satisfied.

  • Prepayment Review Requirements for ZPICs When a ZPIC receives all documentation requested for prepayment review within 45 calendar days of the date of the ADR, the ZPIC shall make and document the review determination and notify the MAC of its determination within 60 calendar days of receiving all requested documentation.

  • In addition, CPI identified the following types of investigations that shall be discussed during the case coordination meetings: • Immediate Advisements (IA);• Extrapolated Overpayment Requests (not associated with a Payment Suspension);• 100% Prepayment Review Requests;• Payment Suspension Requests;• RAP Suppressions;• Revocation Requests;Potential Referrals to Law Enforcement.

  • Prepayment Review Requirements for UPIC/ZPICs When a UPIC/ZPIC receives all documentation requested for prepayment review within 45 calendar days of the date of the ADR, the UPIC/ZPIC shall make and document the review determination and notify the MAC of its determination within 60 calendar days of receiving all requested documentation.

  • This results in denial of payment by HFS for the entire stay.Notice of Preoperative Day(s) Denial – Prepayment Review – This notice is issued when a PR is unable to substantiate the medical necessity of the one or more preoperative days.

Related to Prepayment Review

  • Discount Range Prepayment Response Date has the meaning set forth in Section 2.05(a)(v)(C)(1).

  • Discount Range Prepayment Amount has the meaning set forth in Section 2.05(a)(v)(C)(1).

  • Discount Range Prepayment Notice means a written notice of a Borrower Solicitation of Discount Range Prepayment Offers made pursuant to Section 2.05(a)(v)(C) substantially in the form of Exhibit M-4.

  • Discounted Prepayment Determination Date has the meaning set forth in Section 2.05(a)(v)(D)(3).

  • Prepayment Notice means a notice by the Borrower to prepay Loans, which shall be in such form as the Appropriate Party may approve.

  • Acceptance and Prepayment Notice means a notice of the Borrower’s acceptance of the Acceptable Discount in substantially the form of Exhibit M.

  • Partial Prepayment Amount means the amount required to prepay a portion of the Annual Special Tax obligation for an Assessor’s Parcel as described in Section H.

  • Optional Prepayment Price shall have the meaning set forth in Section 14.02(a).

  • Prepayment Price Has the meaning specified in Section 6.02(b) of the Indenture.

  • Prepayment Penalty Schedule A data field in the Mortgage Loan Schedule attached hereto as Exhibit A which sets forth the amount or method of calculation of the Prepayment Penalty Amount and the term during which such Prepayment Penalty Amount is imposed with respect to a Mortgage Loan.

  • Discount Range Prepayment Offer means the irrevocable written offer by a Term Lender, substantially in the form of Exhibit L, submitted in response to an invitation to submit offers following the Auction Agent’s receipt of a Discount Range Prepayment Notice.

  • Specified Discount Prepayment Response Date has the meaning set forth in Section 2.05(a)(v)(B)(1).

  • Mandatory Prepayment Amount for any Debentures shall equal the sum of (i) the greater of: (A) 130% of the principal amount of Debentures to be prepaid, plus all accrued and unpaid interest thereon, or (B) the principal amount of Debentures to be prepaid, plus all other accrued and unpaid interest hereon, divided by the Conversion Price on (x) the date the Mandatory Prepayment Amount is demanded or otherwise due or (y) the date the Mandatory Prepayment Amount is paid in full, whichever is less, multiplied by the VWAP on (x) the date the Mandatory Prepayment Amount is demanded or otherwise due or (y) the date the Mandatory Prepayment Amount is paid in full, whichever is greater, and (ii) all other amounts, costs, expenses and liquidated damages due in respect of such Debentures.

  • Proposed Prepayment Date is defined in Section 8.3(c).

  • Required Prepayment Date as defined in Section 2.15(c).

  • Prepayment Date has the meaning specified in Section 2.05(c).

  • Prepayment Amount means the amount required to prepay the Annual Special Tax obligation in full for an Assessor’s Parcel as described in Section G.

  • ECF Prepayment Amount has the meaning assigned to such term in Section 2.11(b)(i).

  • Prepayment Premium Period means the period during which, if a prepayment of principal occurs, a prepayment premium will be payable by Borrower to Lender. The Prepayment Premium Period is the period from and including the date of this Note until but not including the first day of the Window Period.

  • Final Repayment Date means the date falling on the earlier of (i) the date falling on the sixth anniversary of the Drawdown Date and (ii) 30 November 2023.

  • Prepayment means, with respect to any Receivable, any prepayment, whether in part or in full, in respect of such Receivable.

  • Solicited Discounted Prepayment Response Date has the meaning set forth in Section 2.05(a)(v)(D)(1).

  • Principal Prepayment Amount For any Distribution Date and for any Loan Group, the sum with respect to the Mortgage Loans in such Loan Group of (i) Curtailments received during the Prior Period from such Mortgage Loans and (ii) Payoffs received during the Payoff Period from such Mortgage Loans.

  • Mandatory Prepayment Date as defined in Section 2.12(e).

  • Reinvestment Prepayment Amount with respect to any Reinvestment Event, the Reinvestment Deferred Amount relating thereto less any amount expended prior to the relevant Reinvestment Prepayment Date to acquire or repair assets useful in the Borrower’s business.

  • Prepayment Period With respect to any Distribution Date, the calendar month preceding the calendar month in which such Distribution Date occurs.