Claims Certification and Program Integrity. Contractor shall comply with the following requirements in the provision of mental health services. 1. Contractor shall comply with all state and federal statutory and regulatory requirements for certification of claims, including Title 42, Code of Federal Regulations (CFR) Part 438, Sections 438.604, 438.606, and, as effective August 13, 2003, Section 438.608, as published in the June 14, 2002 Federal Register (Vol. 67, No. 115, Page 41112), which are hereby incorporated by reference. 2. Contractor certifies the following to the County, in writing under penalty of perjury, for each claim submitted to the County for reimbursement for each beneficiary with services included in the claim: (a) An assessment of the beneficiary was conducted in compliance with the requirements established in this agreement. (b) The beneficiary was eligible to receive Medi-Cal services at the time the services were provided to the beneficiary. (c) The services included in the claim were actually provided to the beneficiary. (d) Medical necessity was established for the beneficiary as defined under California Code of Regulations, Title 9, Division 1, Chapter 11, for the service or services provided, for the timeframe in which the services were provided. (e) A client plan was developed and maintained for the beneficiary that met all client plan requirements established in this agreement. (f) For each beneficiary with specialty mental health services included in the claim, all requirements for Contractor payment authorization for specialty mental health services were met, and any reviews for such service or services were conducted prior to the initial authorization and any re-authorization periods as established in this agreement. (g) Services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. 3. Except as provided in Exhibit A, Paragraph B, relative to medical records, Contractor agrees to keep for a minimum period of three years from the date of service a printed representation of all records, which are necessary to disclose fully the extent of services furnished to the client. Contractor agrees to furnish these records and any information regarding payments claimed for providing the services, on request, within the State of California, to the California Department of Health Services; the Medi-Cal Fraud Unit; California Department of Mental Health; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services, Managed Risk Medical Insurance Board or their duly authorized representatives, or the County. O. Beneficiary Billing Contractor shall not submit a claim to, demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health or related administrative services provided under this contract except to collect other health insurance coverage, share of cost and co-payments. The Contractor shall not hold beneficiaries liable for debts in the event that the County becomes insolvent, for costs of covered services for which the State does not pay the County, for costs of covered services for which the State or the County does not pay the Contractor, for costs of covered services provided under this or other contracts, referral or other arrangement rather than from the County, or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary with an emergency psychiatric condition.
Appears in 1 contract
Sources: Services Agreement
Claims Certification and Program Integrity. Contractor shall comply with the following requirements in the provision of mental health services.
1. Contractor shall comply with all state and federal statutory and regulatory requirements for certification of claims, including Title 42, Code of Federal Regulations (CFR) Part 438, Sections 438.604, 438.606, and, as effective August 13, 2003, Section 438.608, as published in the June 14, 2002 Federal Register (Vol. 67, No. 115, Page 41112), which are hereby incorporated by reference.
2. Anytime Contractor certifies the following to the County, in writing under penalty of perjury, for each submits a claim submitted to the County for reimbursement for services provided under Exhibit A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California.
3. The certification shall attest to the following for each beneficiary with services included in the claim:
(a) a. An assessment of the beneficiary was conducted in compliance with the requirements established in this agreement.
(b) b. The beneficiary was eligible to receive Medi-Cal services described in Exhibit A of this Agreement at the time the services were provided to the beneficiary.
(c) c. The services included in the claim were actually provided to the beneficiary.
(d) d. Medical necessity was established for the beneficiary as defined under California Code of Regulations, Title 9, Division 1, Chapter 11, for the service or services provided, for the timeframe in which the services were provided.
(e) e. A client plan was developed and maintained for the beneficiary that met all client plan requirements established in this agreement.
(f) f. For each beneficiary with (day rehabilitation / day treatment intensive / EPSDT supplemental specialty mental health services services) included in the claim, all requirements for Contractor payment authorization for (day rehabilitation / day treatment intensive / EPSDT supplemental specialty mental health services services) were met, and any reviews for such service or services were conducted prior to the initial authorization and any re-authorization periods as established in this agreement.
(g) g. Services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability.
34. Except as provided in Paragraph II.A. of Exhibit A, Paragraph B, A relative to medical records, Contractor agrees to keep for a minimum period of three (3) years from the date of service a printed representation of all records, records which are necessary to disclose fully the extent of services furnished to the client. Contractor agrees to furnish these records and any information regarding payments claimed for providing the services, on request, within the State of California, to the California Department of Health Services; the Medi-Cal Fraud Unit; California Department of Mental Health; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services, Managed Risk Medical Insurance Board or their duly authorized representatives, or and/or the County. O. Beneficiary Billing Contractor shall not submit a claim to, demand or otherwise collect reimbursement from, San Mateo County Behavioral Health and Recovery Services is required to bill all other insurance (including Medicare) before billing Medi-Cal for beneficiaries who have other coverage in addition to Medi-Cal. This is called “serial billing.” All claims sent to Medi- Cal without evidence of other insurance having been billed first will be denied. In order to comply with the beneficiary or persons acting on behalf serial billing requirement you must elect which of the beneficiary for any specialty mental health or related administrative services provided under this two following options to use in our contract except with you. In either case, you will need to establish the eligibility of your clients through the completion of the standard form (Payor Financial Form) used to collect this information. Please select and complete one of the two options below: Our agency will bill other health insurance, and provide San Mateo County Behavioral Health and Recovery Services (SMCBHRS) with a copy of the Explanation of Benefits provided by that insurance coverageplan before billing SMCBHRS for the remainder. We Unity Care Group, share Inc. elect option one. Signature of cost authorized agent Name of authorized agent Telephone number Our agency will provide information to San Mateo County Behavioral Health and coRecovery Services (SMCBHRS) so that SMCBHRS may bill other insurance before billing Medi-paymentsCal on our agency’s behalf. The Contractor shall not hold beneficiaries liable This will include completing the attached client Payor Financial Form and providing it to the SMCBHRS Billing Office with the completed “assignment” that indicates the client’s permission for debts in the event that the County becomes insolventSMCBHRS to bill their insurance. We Unity Care Group, Inc. elect option two. Signature of authorized agent Name of authorized agent Telephone number Please note if your agency already bills private insurance including Medicare for costs services you provide, then you must elect Option One. This is to prevent double billing. Please return this completed form to: ▇▇▇▇▇▇ ▇▇▇▇▇, Business Systems Manager Behavioral Health and Recovery Services ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇ San Mateo, CA ▇▇▇▇▇ (▇▇▇) ▇▇▇-▇▇▇▇ Client Date of covered services for which the State does not pay the CountyBirth Undocumented? □ Yes □ No If no, for costs of covered services for which the State or the County does not pay the Contractor, for costs of covered services provided under this or other contracts, referral or other arrangement rather than from the County, or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary with an emergency psychiatric condition.Social Security Number (Required) 26.5 (AB3632) □ Yes □ No IEP (SELPA) start date
Appears in 1 contract
Sources: Professional Services
Claims Certification and Program Integrity. Contractor shall comply with the following requirements in the provision of mental health services.
1. Contractor shall comply with all state and federal statutory and regulatory requirements for certification of claims, including Title 42, Code of Federal Regulations (CFR) Part 438, Sections 438.604, 438.606, and, as effective August 13, 2003, Section 438.608, as published in the June 14, 2002 Federal Register (Vol. 67, No. 115, Page 41112), which are hereby incorporated by reference.
2. Anytime Contractor certifies the following to the County, in writing under penalty of perjury, for each submits a claim submitted to the County for reimbursement for services provided under Exhibit A of this Agreement, Contractor shall certify by signature that the claim is true and accurate by stating the claim is submitted under the penalty of perjury under the laws of the State of California. The claim must include the following language and signature line at the bottom of the form(s) and/or cover letter used to report the claim. Executed at California, on , 20 Signed Title Agency ”
3. The certification shall attest to the following for each beneficiary with services included in the claim:
(a) a. An assessment of the beneficiary was conducted in compliance with the requirements established in this agreement.
(b) b. The beneficiary was eligible to receive Medi-Cal services described in Exhibit A of this Agreement at the time the services were provided to the beneficiary.
(c) c. The services included in the claim were actually provided to the beneficiary.
(d) d. Medical necessity was established for the beneficiary as defined under California Code of Regulations, Title 9, Division 1, Chapter 11, for the service or services provided, for the timeframe in which the services were provided.
(e) e. A client plan was developed and maintained for the beneficiary that met all client plan requirements established in this agreement.
(f) f. For each beneficiary with specialty mental health services included in the claim, all requirements for Contractor payment authorization for specialty mental health services were met, and any reviews for such service or services were conducted prior to the initial authorization and any re-authorization periods as established in this agreement.
(g) g. Services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability.
34. Except as provided in Paragraph IV.A. of Exhibit A, Paragraph B, A relative to medical records, Contractor agrees to keep for a minimum period of three years from the date of service a printed representation of all records, records which are necessary to disclose fully the extent of services furnished to the client. Contractor agrees to furnish these records and any information regarding payments claimed for providing the services, on request, within the State of California, to the California Department of Health Services; the Medi-Cal Fraud Unit; California Department of Mental Health; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services, Managed Risk Medical Insurance Board or their duly authorized representatives, or and/or the County. O. Beneficiary Billing Contractor shall not submit a claim to, demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health or related administrative services provided under this contract except to collect other health insurance coverage, share of cost and co-payments. The Contractor shall not hold beneficiaries liable for debts in the event that the County becomes insolvent, for costs of covered services for which the State does not pay the County, for costs of covered services for which the State or the County does not pay the Contractor, for costs of covered services provided under this or other contracts, referral or other arrangement rather than from the County, or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary with an emergency psychiatric condition.
Appears in 1 contract
Sources: Agreement
Claims Certification and Program Integrity. Contractor shall comply with the following requirements in the provision of mental health services.
1. Contractor shall comply with all state and federal statutory and regulatory requirements for certification of claims, including Title 42, Code of Federal Regulations (CFR) Part 438, Sections 438.604, 438.606, and, as effective August 13, 2003, Section 438.608, as published in the June 14, 2002 Federal Register (Vol. 67, No. 115, Page 41112), which are hereby incorporated by reference.
2. Contractor certifies the following to the County, in writing under penalty of perjury, for each claim submitted to the County for reimbursement for each beneficiary with services included in the claim:
(a) An assessment of the beneficiary was conducted in compliance with the requirements established in this agreement.
(b) The beneficiary was eligible to receive Medi-Cal services at the time the services were provided to the beneficiary.
(c) The services included in the claim were actually provided to the beneficiary.
(d) Medical necessity was established for the beneficiary as defined under California Code of Regulations, Title 9, Division 1, Chapter 11, for the service or services provided, for the timeframe in which the services were provided.
(e) A client plan was developed and maintained for the beneficiary that met all client plan requirements established in this agreement.
(f) For each beneficiary with specialty mental health services included in the claim, all requirements for Contractor payment authorization for specialty mental health services were met, and any reviews for such service or services were conducted prior to the initial authorization and any re-authorization periods as established in this agreement.
(g) Services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability.
3. Except as provided in Exhibit A, II, Paragraph B, relative to medical records, Contractor agrees to keep for a minimum period of three years from the date of service a printed representation of all records, which are necessary to disclose fully the extent of services furnished to the client. Contractor agrees to furnish these records and any information regarding payments claimed for providing the services, on request, within the State of California, to the California Department of Health Services; the Medi-Medi- Cal Fraud Unit; California Department of Mental Health; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services, Managed Risk Medical Insurance Board or their duly authorized representatives, or the County. O. Beneficiary Billing Contractor shall not submit a claim to, demand or otherwise collect reimbursement from, the beneficiary or persons acting on behalf of the beneficiary for any specialty mental health or related administrative services provided under this contract except to collect other health insurance coverage, share of cost and co-payments. The Contractor shall not hold beneficiaries liable for debts in the event that the County becomes insolvent, for costs of covered services for which the State does not pay the County, for costs of covered services for which the State or the County does not pay the Contractor, for costs of covered services provided under this or other contracts, referral or other arrangement rather than from the County, or for payment of subsequent screening and treatment needed to diagnose the specific condition of or stabilize a beneficiary with an emergency psychiatric condition.
Appears in 1 contract
Sources: Professional Services