Provider Audits definition

Provider Audits. Providers receiving funds under this Agreement, for providing A&D 81 Services, are subject to audits of all funds applicable to A&D 81 Services rendered. The purpose of these audits is to:
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Provider Audits has the meaning set forth in Section 14.1(e)(i) of the Master Agreement.
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Examples of Provider Audits in a sentence

  • The OHCA Provider Audits Unit conducts ongoing monitoring of services to ensure Medicaid guidelines are followed.

  • AIA CES Provider Audits AIA CES reserves the right in its sole discretion to audit AIA CES Providers to ensure compliance with AIA policies and procedures, including, but not limited to the CES guidelines outlined in this manual.

  • Provider Audits - ExtrapolationWe may review paid claims to help ensure payment integrity.

  • OHA may apply the Division of Medical Assistance Program (DMAP) Provider Audit rules and the Fraud and Abuse rules to providers and provider sub-contractors of A&D 82 Services in accordance with OAR 410-120-1505 through 410-120-1510 Provider Audits, as such rules may be revised from time to time.

  • In addition to the six month utilization review and allocation adjustment, additional funding adjustments may be made at the request of the provider or DHHS.B. Provider Audits.

  • Line Item Name(1) Executive Director's Office: (F) Provider Audits and ServicesProfessional Audit ContractsIncludes funding for contracting with an independent accounting firm to perform audits of nursing facility cost reports for rate setting.

  • Provider Audits and Reviews The MCOs and the SCDHHS Division of Program Integrity will collaborate on provider program integrity reviews as much as possible.

  • Her country valued the Agency’s technical cooperation highly and had always contributed its target share of the TCF in full.

  • ISSUE RESOLUTION Service Provider-to-Service Provider Audits Issue A.

  • Provider must cooperate fully with the audit, promptly comply with all requests for documentation and records, and comply with MedImpact’s audit policies and procedures (including the MedImpact Provider Auditing Guidelines – Provider Audits and Appeals, which are incorporated herein).

Related to Provider Audits

  • Provider agency means a funded organization under contract with the Children’s Board to deliver and provide social services and supports to children and families of Hillsborough County, FL.

  • Provider Service means a Provider’s hosted online services (if any) as described in the Solution Exhibit which is provided by Provider to Customers located in the Territory through remote access via the Internet as part of the BPO Service. A Provider Platform Application shall be considered a Provider Service.

  • Provider Agreements means all participation, provider and reimbursement agreements or arrangements now or hereafter in effect for the benefit of Tenant or any Manager in connection with the operation of any Facility relating to any right of payment or other claim arising out of or in connection with Tenant’s participation in any Third Party Payor Program.

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

  • Provider panel means those providers with which a carrier contracts to provide health care services

  • Provider Manual means a working document, including but not limited to BCBSM published bulletins and provider notices, that provide specific guidelines and direction by which providers may meet their contractual responsibility as described in this Agreement. Provider Manuals are published on web-DENIS.

  • Provider Enrollment means an agreement between the Department and a Medicaid provider to provide room and board and deliver care and services to a Medicaid eligible individual in an adult foster home for compensation.

  • Provider fee means the consideration paid for a service contract.

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other entity administering the Medicaid program and a health care operation under which the health care operation agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Provider is any individual or company that provides professional or technical services.

  • Provider Group means a medical group, independent

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Providers means individuals or organizations --------- licensed to practice dentistry (including specialists) as well as other dental professionals who provide ancillary reimbursable dental services.

  • ProviderOne or “P1” means the system commonly referred to as the Medicaid Management Information System (MMIS), and is the federally approved system used by the Washington Medicaid program to pay provider claims for goods and services authorized under the State Plan. The MMIS is certified by CMS and is the primary information system used by HCA to pay for health care.

  • Provider of health care means a physician or physician assistant licensed pursuant to chapter 630, 630A or 633 of NRS, perfusionist, dentist, licensed nurse, dispensing optician, optometrist, practitioner of respiratory care, registered physical therapist, podiatric physician, licensed psychologist, licensed audiologist, licensed speech-language pathologist, licensed hearing aid specialist, licensed marriage and family therapist, licensed clinical professional counselor, chiropractor, licensed dietitian or doctor of Oriental medicine in any form.

  • Medical care facility as used in this title, means any institution, place, building or agency, whether

  • Provider Personnel means all persons employed or engaged by the Provider together with the Provider’s servants, agents, consultants and Sub-Contractors (and all persons employed by any Sub-Contractor together with the Sub-Contractor’s servants, consultants, agents, Provider’s and Sub-Contractors) used in the performance of its obligations under this Agreement;

  • Provider Organization means a group practice, facility, or organization that is:

  • Provider Advance means a Downgrade Advance or a Non-Extension Advance.

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.

  • Non-Administrator Dialysis Facility means a Dialysis Facility which does not have an agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan but has been certified in accordance with the guidelines established by Medicare.

  • Credentialing means the process of collecting, assessing, and validating qualifications and other relevant information pertaining to a health care provider to determine eligibility and to deliver Covered Services.

  • Emergency medical services provider means a person who has received formal training in prehospital and emergency care, and is licensed to attend any person who is ill or injured or who has a disability. Police officers, firefighters, funeral home employees and other persons serving in a dual capacity one of which meets the definition of “emergency medical services provider” are “emergency medical services providers” within the meaning of this chapter.

  • Local Service Provider (LSP means the LEC that provides retail local Exchange Service to an End User. The LSP may or may not provide any physical network components to support the provision of that End User’s service.