Common use of Service Verification Clause in Contracts

Service Verification. (A) The Contractor shall have policies and procedures to verify, by sampling or other methods, that services billed by Providers were received by the Contractor’s Enrollees. (B) If the Contractor uses sampling procedures specified below to verify that services were provided, the Contractor's written policies and procedures must include that: (1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the SFY for service verification; (2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes: (i) the Enrollee’s name and Medicaid ID number; (ii) the date of each contact (if a prior attempt was unsuccessful); (iii) the method of contact; (iv) whether the Enrollee responded to the contact; and (v) whether the Enrollee indicated he or she obtained the service; and (3) the Contractor shall keep copies of correspondence. (C) If the Contractor uses methods other than the sampling procedures specified in Article 6.1.6(B) of this attachment to verify services billed by Providers were received by the Contractor's Enrollees, the Contractor's written policies and procedures shall include a detailed description of the method(s) to be used.

Service Verification. (A) The Contractor shall have written policies and procedures to verify, by sampling or other methods, that services billed by Providers were received by the Contractor’s Enrollees. (B) If the Contractor uses sampling procedures specified below to verify that services were provided, the Contractor's written policies and procedures must include that: (1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the SFY for service verification; (2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes: (i) the Enrollee’s name and Medicaid ID number; (ii) the date of each contact (if a prior attempt was unsuccessful); (iii) the method of contact; (iv) whether the Enrollee responded to the contact; and (v) whether the Enrollee indicated he or she obtained the service; and (3) the Contractor shall keep copies of correspondence. (C) If the Contractor uses methods other than the sampling procedures specified in Article 6.1.6(B) of this attachment to verify services billed by Providers were received by the Contractor's Enrollees, the Contractor's written policies and procedures shall include a detailed description of the method(s) to be used. (D) The Contractor shall submit an annual SFY report to the Department by November 1st of each year, in a Department-specified format, documenting that service verifications were performed.

Service Verification. (A) The Contractor shall have written policies and procedures to verify, by sampling or other methods, that services billed by Providers were received by the Contractor’s 's Enrollees. (B) If lf the Contractor uses sampling procedures specified below to verify that services were provided, the Contractor's written policies and procedures must include that: (1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the SFY for service verification; (2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes: (i) the Enrollee’s 's name and Medicaid ID CHlP lD number; (ii) the date of each contact (if a prior attempt was unsuccessful); (iii) the method of contact; (iv) whether the Enrollee responded to the contact; and (v) whether the Enrollee indicated he or she obtained the service; and (3) the Contractor shall keep copies of correspondence. (C) If lf the Contractor uses methods other than the sampling procedures specified in Article 6.1.6(B) of this attachment to verify services billed by Providers were received by the Contractor's Enrollees, the Contractor's written policies and procedures shall include a detailed description of the method(s) to be used. (D) The Contractor shall submit an annual SFY report to the Department by November 1st of each year, in a Department-specified format, documenting that service verifications were performed.

Service Verification. (A) The Contractor shall have policies and procedures to verify, by sampling or other methods, that services billed by Providers were received by the Contractor’s Enrollees. (B) If the Contractor uses sampling procedures specified below to verify that services were provided, the Contractor's written policies and procedures must include that: (1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the SFY for service verification; (2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes: (i) the Enrollee’s name and Medicaid ID number; (ii) the date of each contact (if a prior attempt was unsuccessful); (iii) the method of contact; (iviii) whether the Enrollee responded to the contact; and (viv) whether the Enrollee indicated he or she obtained the service; and (3) the Contractor shall keep copies of correspondence. (C) If the Contractor uses methods other than the sampling procedures specified in Article 6.1.6(B) of this attachment to verify services billed by Providers were received by the Contractor's Enrollees, the Contractor's written policies and procedures shall include a detailed description of the method(s) to be used. (D) to submit a report to the Department by November 1st of each year, in a Department specified format, documenting that service verifications were performed.