Claims Submission Processing and Compensation Clause Samples
Claims Submission Processing and Compensation. 1. Claims or Encounter Submission. Provider shall promptly submit to MCNA claims or encounters for Covered Services in accordance with the Provider Manual. MCNA reserves the right to deny payment to Provider if Provider fails to submit its claims in accordance with the Provider Manual. If applicable based on Provider’s compensation arrangement, Provider shall submit encounter data to MCNA in a timely fashion, which shall contain such statistical and descriptive dental and patient data and identifying information as specified in the Provider Manual. Provider will be given at least 30 days advance notice of any changes to the Provider Manual unless the changes are required in a shorter time period by State Agency, law, or regulation.
Claims Submission Processing and Compensation. 3.1. Claims or Encounter Data Submission. As provided in the Provider Manual and/or Policies, Contracted Providers shall submit to Payor or its delegate claims for payment for Covered Services rendered to Covered Persons. Contracted Provider shall submit encounter data to Payor or its delegate in a timely fashion, which must contain patient data and identifying information, diagnosis and service codes, and provider identifiers, if and as required in the Provider Manual. Payor or its delegate reserves the right to deny payment to the Contracted Provider if the Contracted Provider fails to submit claims for payment or encounter data in accordance with the Provider Manual and/or Policies.
Claims Submission Processing and Compensation