Common use of CLAIMS CERTIFICATION Clause in Contracts

CLAIMS CERTIFICATION. The Provider agrees and shall certify under penalty of perjury that all claims for services submitted electronically have been personally provided to the patient by the Provider or under his direction by another person eligible under the Medi‑Cal Program to provide to such services, and such person(s) are designated on the claim. The services were, to the best of the Provider's knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department during that period of time. The Provider/Xxxxxx 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 HealthCare Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that using his Medi-Cal Submitter ID plus DHCS-issued password when submitting an electronic claim will identify the submitter and shall serve as acceptance to the terms and conditions of the Department’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS 6153), paragraph 3.0. The Provider/Xxxxxx further acknowledges the necessity of maintaining the privacy of the DHCS‑issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter ID and password should privacy not be maintained.

CLAIMS CERTIFICATION. The Provider agrees and shall certify under penalty of perjury that all claims for services submitted electronically have been personally provided to the patient by the Provider or under his direction by another person eligible under the Medi‑Cal Medi-Cal Program to provide to such services, and such person(s) are designated on the claim. The services were, to the best of the Provider's knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department during that period of time. The Provider/Xxxxxx 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 HealthCare Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that using his Medi-Cal Submitter ID plus DHCS-issued password when submitting an electronic claim will identify the submitter and shall serve as acceptance to the terms and conditions of the Department’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS 6153), paragraph 3.0. The Provider/Xxxxxx further acknowledges the necessity of maintaining the privacy of the DHCS‑issued DHCS-issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter ID and password should privacy not be maintained.

CLAIMS CERTIFICATION. The Provider agrees and shall certify under penalty of perjury that all claims for services submitted electronically have been personally provided to the patient by the Provider or or, under his direction direction, by another person eligible under the Medi‑Cal Program CHDP program to provide to such services, and such person(s) are designated on the claim. The services were, to the best of the Provider's ’s knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify that all information submitted electronically is accurate and complete. The Provider understands that payment of these any payments for claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department during that period of time. The Provider/Xxxxxx 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 HealthCare Health Care Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that using his Medi-Cal Submitter ID plus DHCS-issued password when submitting an to include with each electronic claim will identify claims submission, submitted through the submitter and batch CMC system, a certification statement, which shall serve as acceptance certify to the following: I submit these claims under penalty of perjury in accordance with the terms and conditions of the Department’s Department of Health Care Services’ CHDP Telecommunications Provider and Xxxxxx Application/Agreement form (DHCS 61534431), paragraph 3.0. The Provider/Xxxxxx further acknowledges the necessity of maintaining the privacy of the DHCS‑issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter ID and password should privacy not be maintained3.

CLAIMS CERTIFICATION. The Provider agrees by claims submission and shall certify certifies under penalty of perjury that all services for which claims for services are submitted electronically have been personally provided to the patient member by the Provider or under his or her direction by another person eligible under the Medi‑Cal Program Medi-Cal program to provide to such services, and such person(s) are designated on the claim. The Provider also certifies by claims submission that the services were, to the best of the Provider's knowledge, medically indicated and necessary to the health of the patientmember. The Provider shall also certify certifies that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patientmember. A printed representation of those records shall be produced upon request of the Department during that period of time. The Provider/Xxxxxx 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 HealthCare Health Care Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical dental care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that when applicable using his or her Medi-Cal Submitter Dental Remote ID plus DHCS-issued password when submitting an electronic claim will identify the submitter and shall serve as acceptance to of the terms and conditions of the Department’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS 6153ENBPROV), paragraph 3.0. The Provider/Xxxxxx further acknowledges the necessity of maintaining the privacy of the DHCS‑issued DHCS-issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter Dental Remote ID and password should privacy not be maintained.

CLAIMS CERTIFICATION. The Provider agrees and shall certify under penalty of perjury that all claims for services submitted electronically have been personally provided to the patient by the Provider or under his direction by another person eligible under the Medi‑Cal Medi-Cal Program to provide to such services, and such person(s) are designated on the claim. The services were, to the best of the Provider's ’s knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three years from the date of service an electronic archive of all records necessary to fully full disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department during that period of time. The Provider/Xxxxxx 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 HealthCare Health Care Services; , California Department of Justice; , Office of the State Controller; , U.S. Department of Health and Human Services; , or their duly authorized representatives. The Provider also agrees that medical care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that using his Medi-Cal Submitter ID plus DHCS-issued password when submitting an electronic claim will identify the submitter and shall serve as acceptance to the terms and conditions of the Department’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS 6153), paragraph 3.0. The Provider/Xxxxxx further acknowledges the necessity of maintaining the privacy of the DHCS‑issued DHCS-issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter ID and password should privacy not be maintained.

CLAIMS CERTIFICATION. The Provider agrees and shall certify under penalty of perjury that all claims for services submitted electronically have been personally provided to the patient by the Provider or under his direction by another person eligible under the Medi‑Cal Medi-Cal Program to provide to such services, and such person(s) are designated on the claim. The services were, to the best of the Provider's knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department during that period of time. The Provider/Xxxxxx 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 HealthCare Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that using his Medi-Cal Submitter ID plus DHCS-issued password when submitting an electronic claim will identify the submitter and shall serve as acceptance to the terms and conditions of the Department’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS 6153), paragraph 3.0. The Provider/Xxxxxx further acknowledges the necessity of maintaining the privacy of the DHCS‑issued DHCS-issued password and agrees to bear full responsibility for use or misuse of the Medi-Medi- Cal Submitter ID and password should privacy not be maintained.

CLAIMS CERTIFICATION. The Provider agrees and shall certify under penalty of perjury that all claims for services submitted electronically have been personally provided to the patient by the Provider or under his direction by another person eligible under the Medi‑Cal Medi-Cal Program to provide to such services, and such person(s) are designated on the claim. The services were, to the best of the Provider's ’s knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three (3) years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department Plan during that period of time. The Provider/Xxxxxx 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 HealthCare Health Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that using his Medi-Cal Submitter ID plus DHCS-CCAH issued password when submitting an and electronic claim will identify the submitter and shall serve as acceptance to the terms and conditions of the DepartmentPlan’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS 6153)Electronic Health Care Claim Agreement, paragraph 3.0. The Provider/Xxxxxx Provider further acknowledges the necessity of maintaining the privacy of the DHCS‑issued CCAH-issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter ID and CCAH password should privacy not be maintained.

CLAIMS CERTIFICATION. The Provider agrees by claims submission and shall certify certifies under penalty of perjury that all services for which claims for services are submitted electronically have been personally provided to the patient by the Provider or under his or her direction by another person eligible under the Medi‑Cal Program Medi-Cal program to provide to such services, and such person(s) are designated on the claim. The Provider also certifies by claims submission that the services were, to the best of the Provider's knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify certifies that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department during that period of time. The Provider/Xxxxxx 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 HealthCare Health Care Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical dental care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that when applicable using his or her Medi-Cal Submitter Dental Remote ID plus DHCS-issued password when submitting an electronic claim will identify the submitter and shall serve as acceptance to of the terms and conditions of the Department’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS 6153ENBPROV), paragraph 3.0. The Provider/Xxxxxx further acknowledges the necessity of maintaining the privacy of the DHCS‑issued DHCS-issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter Dental Remote ID and password should privacy not be maintained.

CLAIMS CERTIFICATION. The Provider agrees and shall certify under penalty of perjury that all claims for services submitted electronically have been personally provided to the patient by the Provider or under his direction by another person eligible under the Medi‑Cal Medi-Cal Program to provide to such services, and such person(s) are designated on the claim. The services were, to the best of the Provider's ’s knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three (3) years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department Plan during that period of time. The Provider/Xxxxxx 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 HealthCare Health Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that using his Medi-Cal Submitter ID plus DHCS-CCAH issued password when submitting an and electronic claim will identify the submitter and shall serve as acceptance to the terms and conditions of the DepartmentPlan’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS 6153CCAH 1001), paragraph 3.0. The Provider/Xxxxxx Provider further acknowledges the necessity of maintaining the privacy of the DHCS‑issued CCAH-issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter ID and CCAH password should privacy not be maintained.

CLAIMS CERTIFICATION. The Provider agrees and shall certify under penalty of perjury that all claims for services submitted electronically have been personally provided to the patient by the Provider or under his direction by another person eligible under the Medi‑Cal Program to provide to such services, and such person(s) are designated on the claim. The services were, to the best of the Provider's knowledge, medically indicated and necessary to the health of the patient. The Provider shall also certify that all information submitted electronically is accurate and complete. The Provider understands that payment of these claims will be from federal and/or state funds, and that any falsification or concealment of a material fact may be prosecuted under federal and/or state laws. The Provider/Xxxxxx agrees to keep for a minimum period of three years from the date of service an electronic archive of all records necessary to fully disclose the extent of services furnished to the patient. A printed representation of those records shall be produced upon request of the Department during that period of time. The Provider/Xxxxxx 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 HealthCare Health Services; California Department of Justice; Office of the State Controller; U.S. Department of Health and Human Services; or their duly authorized representatives. The Provider also agrees that medical care services are offered and provided without discrimination based on race, religion, color, national or ethnic origin, sex, age, or physical or mental disability. The Provider/Xxxxxx agrees that using his Medi-Cal Submitter ID plus DHCSDHS-issued password when submitting an electronic claim will identify the submitter and shall serve as acceptance to the terms and conditions of the Department’s Telecommunications Provider and Xxxxxx Application/Agreement (DHCS DHS 6153), paragraph 3.0. The Provider/Xxxxxx further acknowledges the necessity of maintaining the privacy of the DHCS‑issued DHS‑issued password and agrees to bear full responsibility for use or misuse of the Medi-Cal Submitter ID and password should privacy not be maintained.