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: (a) Ensure proper disbursements were made for covered A&D 81 Services; (b) Recover over-payments; (c) Discover any potential or actual instances of fraud and abuse; and (d) Verify that encounter data submissions are documented in the client file, as required and described in the “Special Reporting Requirements” above.
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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

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

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

  • The Annual Audit Plan will include: (i) Operational and Financial Audits to be performed by or on behalf of Customer during such year; and (ii) the timing and scope of Provider Audits to be provided by Provider to Customer as part of the Services.

  • 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.

  • 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.

  • 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).

  • This audit was conducted in accordance with the Guideline for Metering Equipment Provider Audits V1.3, which was published by the Electricity Authority.

  • On-Call Audit Services (Covered Provider Audits and/or Compliance Audits) will follow audit periods detailed in each request to exercise a service, as needed and as detailed in Annex E of the Form of Contract (Section 6 of this RFP).

  • Service requirements and performance standards applicable to the professional services component contractors of the IME, including the SURS Analysis and Provider Audits Component Contractor, are set forth in Section 6.1 of RFP MED 04-015 and are incorporated herein by reference.

  • The board unanimously adopted a policy to pay CPF expenses for 2018-2019 fiscal period.

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 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 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 such entity administering the Medicaid program and a health care provider or supplier under which the health care provider or supplier 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 CMS, and a health care provider or supplier under which the 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.

  • 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.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • Internet Service Provider (ISP) means an Enhanced Service Provider (ESP) that provides Internet Services.