Provider Overpayment definition

Provider Overpayment means a payment made by the Authority or Contractor to a Provider in excess of the correct payment amount for a service.
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Examples of Provider Overpayment in a sentence

  • Returning overpayments to SCANProviders have two options to repay identified overpayment(s) to SCAN: 1 Submit a refund (check)Please be sure to include the check, a completed Provider Overpayment Refund Request Form, and the Overpayment Notice Letter (if applicable) Mail the check to: SCAN Health Plan, 3800 Kilroy Airport Way, Suite 100, Long Beach, CA 90801 Email the overpayment documents to Claimsrecoveryunit@scanhealthplan.com.

  • Providers are required to report any payments made by SCAN for which the provider is not entitled and should notify SCAN in writing via the Provider Overpayment Form.

  • Section 11.4.5: In the event of an established Provider Overpayment or underpayment, the CONTRACTOR shall adjust, void or replace, as appropriate, each encounter claim to reflect the proper claim adjudication.

  • Subject to the exception(s) set forth in this Section 4, Employer agrees that Claim Administrator will recover Overpayments in accordance with its Recovery Process and that Employer has no separate or independent right to recover any Provider Overpayment from Claim Administrator, Providers, or Another Plan.

  • This section contains information pertinent to training the Provider Overpayment & Recovery Manual Section.

  • Non-SSPS Client / Provider Overpayment AFRS Coding Computation, Account coding is required.

  • Note: Prior to a manual recovery transaction, all actions required by BCBST Corporate Provider Overpayment Recovery Policy have been exhausted.

  • Check this box if the SSPS did not make the payment; form DSHS 18-399A Non-SSPS Client / Vendor / Provider Overpayment Notice, AFRS Coding Computation must be attached.

  • This is effective for all overpayment dollars currently due BCBST regardless of when the overpayment was created.Note: Prior to a manual recovery transaction, all actions required by BCBST Corporate Provider Overpayment Recovery Policy have been exhausted.These manual overpayment recoveries will appear on the last page of the Provider’s remittance advice with a narrative description of “Manual Reduction”.

  • Harris, M.D., Medicaid Director RE: Provider Overpayment Disclosure Process Introduction The Affordable Care Act of 2010 (ACA) imposes new federalrequirements on MassHealth providers to timely report and return overpayments received from MassHealth.

Related to Provider Overpayment

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

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

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

  • Unapplied Provider Advance means any Provider Advance other than an Applied Provider Advance.

  • Provider Group means a medical group, independent

  • 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.

  • Social Engineering Security Procedures means security procedures intended to prevent Social Engineering Fraud as set forth in the Application and/or as otherwise provided in writing to the Underwriter.

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

  • Certified pharmacy technician or “certified technician” means an individual who holds a valid current national certification and who has registered with the board as a certified pharmacy technician.

  • Non-Participating Certified Nurse Practitioner means a Certified Nurse Practitioner who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Applied Provider Advance has the meaning assigned to such term in Section 2.06(a).

  • 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.

  • Advanced emergency medical technician or “AEMT” means an individual who has successfully completed a course of study based on the United States Department of Transportation’s Advanced Emergency Medical Technician Instructional Guidelines (January 2009), has passed the psychomotor and cognitive examinations for the AEMT, and is currently certified by the department as an AEMT.

  • Total Service Charges means all charges, after application of all discounts and credits, incurred by Customer for Services provided under this Agreement, excluding Taxes, Governmental Charges, equipment, Company ILEC, Company Wireless, Document Delivery Fax, non-recurring, goods and services acquired by Company as Customer’s agent, international access that is passed-through (Type 3/PTT) or provided by Company (Type 1), charges for security services provided by a Cybertrust Security Service Provider listed in the Guide, and other charges expressly excluded by this Agreement.

  • Certified service provider means an agent certified:

  • Monthly Invoice means an invoice issued in accordance with section 21 by MDL or the Incentives Pool Trustee to a Shipper or Welded Party for all Charges payable in respect of the previous Month by that Shipper or Welded Party, together with any outstanding amounts in respect of any Month prior to the previous Month.

  • Non-Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Deactivation Avoidable Cost Credit means the credit paid to Generation Owners pursuant to Tariff, Part V, section 114.

  • Social Engineering Fraud means the intentional misleading of an Employee through the use of a Communication, where such Communication:

  • Enhanced 911 Service (“E911”) means a telephone communication service which will automatically route a call dialed “9-1-1” to a designated public safety answering point (PSAP) attendant and will provide to the attendant the calling party’s telephone number and, when possible, the address from which the call is being placed and the Emergency Response agencies responsible for the location from which the call was dialed.

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

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

  • Special Hazard Loss Amount As of any Distribution Date, an amount equal to $5,477,967.00 minus the sum of (i) the aggregate amount of Special Hazard Losses allocated solely to the Class B Certificates in accordance with Section 4.02(a) and (ii) the Special Hazard Adjustment Amount (as defined below) as most recently calculated. For each anniversary of the Cut-Off Date, the Special Hazard Adjustment Amount shall be calculated and shall be equal to the amount, if any, by which the amount calculated in accordance with the preceding sentence (without giving effect to the deduction of the Special Hazard Adjustment Amount for such anniversary) exceeds the greater of (A) the product of the Special Hazard Percentage for such anniversary multiplied by the outstanding principal balance of all the Mortgage Loans on the Distribution Date immediately preceding such anniversary, (B) twice the outstanding principal balance of the Mortgage Loan in the Trust Estate which has the largest outstanding principal balance on the Distribution Date immediately preceding such anniversary and (C) that which is necessary to maintain the original ratings on the Certificates as evidenced by letters to that effect delivered by Rating Agencies to the Master Servicer and the Trust Administrator. On and after the Cross-Over Date, the Special Hazard Loss Amount shall be zero.

  • Enhanced Service Provider (ESP) means the provider of enhanced services, as those services are defined in 47 CFR Section 64.702.

  • Appropriate List Matching Data means (A) account registration and alternate payee data, to the extent made appropriate by statutes, rules or regulations governing the U.S. Government Lists, (ii) data determined by BNYM in light of statutes, rules or regulations governing the U.S. Government Lists to be necessary to provide the services described in this Section 3(b)(5), and (iii) data the parties agree in writing to be necessary to provide the services described in this Section 3(b)(5).

  • Non-Participating Certified Nurse-Midwife means a Certified Nurse-Midwife who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.