Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCOP’s claims adjudication, including claims adjudication by a contracted vendor, either electronic or manual, incorrectly underpaying, overpaying, or denying claims that impact, or has the potential to impact, five or more providers. ODM reserves the right to request and receive additional information for ODM to classify an issue as a CPSE.
Appears in 11 contracts
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCOPMCP’s claims adjudication, including claims adjudication by a contracted vendor, either electronic or manual, incorrectly underpaying, overpaying, or denying claims claims. that impact, or has the potential to impact, five or more providers. ODM reserves the right to request and receive additional information for ODM to classify an issue as a CPSE.
Appears in 11 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCOPMCP’s claims adjudication, including claims adjudication by a contracted vendor, either electronic or manual, incorrectly underpaying, overpaying, or denying claims that impact, or has the potential to impact, impact five or more providers. ODM reserves the right to request and receive additional information for ODM to classify an issue as a CPSE.
Appears in 7 contracts
Samples: Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan, Ohio Medical Assistance Provider Agreement for Managed Care Plan
Claims Payment Systemic Errors (CPSEs). For the purpose of this appendix, a CPSE is defined as the MCOP’s claims adjudication, including claims adjudication by a contracted vendor, either electronic or manual, incorrectly underpaying, overpaying, or denying claims that impact, or has the potential to impact, impact five or more providers. ODM reserves the right to request and receive additional information for ODM to classify an issue as a CPSE.
Appears in 2 contracts
Samples: The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan, The Ohio Department of Medicaid Mycare Ohio Provider Agreement for Mycare Ohio Plan
