Common use of Exceptions to the Cost Avoidance Rule Clause in Contracts

Exceptions to the Cost Avoidance Rule. In the following situations, the Contractor shall first pay its Providers and then coordinate with the liable Third Party, unless prior approval to take other action is obtained from ASES: 22.4.5.2.1 The coverage is derived from a parent whose obligation to pay support is being enforced by a government agency. 22.4.5.2.2 The claim is for Maternal and Prenatal Services to a pregnant woman or for EPSDT services that are covered by the Medicaid program. 22.4.5.2.3 The claim is for labor, delivery, and post-partum care and does not involve hospital costs associated with an inpatient stay. 22.4.5.2.4 The claim is for a child who is in the custody of ADFAN. 22.4.5.2.5 The claim involves coverage or services mentioned in this subsection in combination with another service.

Exceptions to the Cost Avoidance Rule. In the following situations, the Contractor shall first pay its Providers and then coordinate with the liable Third Party, unless prior approval to take other action is obtained from ASES: 22.4.5.2.1 23.4.5.2.1 The coverage is derived from a parent whose obligation to pay support is being enforced by a government agency. 22.4.5.2.2 23.4.5.2.2 The claim is for Maternal and Prenatal Services to a pregnant woman or for EPSDT services that are covered by the Medicaid program. 22.4.5.2.3 23.4.5.2.3 The claim is for labor, delivery, and post-partum care and does not involve hospital costs associated with an inpatient stay. 22.4.5.2.4 23.4.5.2.4 The claim is for a child who is in the custody of ADFAN. 22.4.5.2.5 23.4.5.2.5 The claim involves coverage or services mentioned in this subsection in combination with another service.

Exceptions to the Cost Avoidance Rule. In the following situations, the Contractor shall first pay its Providers and then coordinate with the liable Third Party, unless prior approval to take other action is obtained from ASES: 22.4.5.2.1 23.4.5.2.1 The coverage is derived from a parent whose obligation to pay support is being enforced by a government agency. 22.4.5.2.2 23.4.5.2.2 The claim Claim is for Maternal maternal and Prenatal Services prenatal services to a pregnant woman or for EPSDT services that are covered by the Medicaid program. 22.4.5.2.3 23.4.5.2.3 The claim Claim is for labor, delivery, and post-partum care and does not involve hospital costs associated with an inpatient stay. 22.4.5.2.4 23.4.5.2.4 The claim Claim is for a child who is in the custody of ADFAN. 22.4.5.2.5 23.4.5.2.5 The claim Claim involves coverage or services mentioned in this subsection Section in combination with another service.