Denial of payment definition

Denial of payment means that the department has denied payment for a medical assistance claim or reduced the level of service payment for a service provided to an individual who was an eligible medical assistance recipient at the time the service was provided or the recoupment or adjustment of a claim, or part of a claim, following an audit or review.
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Denial of payment means that the department has denied payment for a medical assistance claim or reduced the level of service payment for a service provided to an individual who was an eligible medical assistance recipient at the time the service was provided.
Sample 1Sample 2Sample 3

Examples of Denial of payment in a sentence

  • If a facility does not meet the criteria for continuation of payment under subrule 81.37(1), the facility’s provider agreement shall be terminated.81.37(3) Denial of payment.

  • If an acceptable ePoC is not received within 10 calendar days from the receipt of this letter, we will recommend to the CMS Region V Office that one or more of the following remedies be imposed: • Denial of payment for new Medicare and Medicaid admissions (42 CFR 488.417); • Civil money penalty (42 CFR 488.430 through 488.444).

  • Denial of payment for procedures performed without prior authorization.

  • Denial of payment of health care services provided pursuant to the Act, whether in whole or in part, shall be accompanied with written explanation for reason for denial.

  • Denial of payment by the state agency or payment of a claim by the vendor for a vendor violation(s) shall not absolve the vendor of the violation(s).

  • The alter- native sanctions that CMS may apply in the circumstances specified in para- graph (a) of this section include the fol- lowing:(1) Denial of payment for services furnished to patients first accepted for care after the effective date of the sanction as specified in the sanction notice.(2) Reduction of payments, for all ESRD services furnished by the sup- plier, by 20 percent for each 30-day pe- riod after the effective date of the sanction.

  • Denial of payment for any Service(s) rendered by Provider arising from this Contract must be appealed to HCJFS within sixty (60) business days from receipt of the payment denial.

  • Denial of payment for procedures on the Inpatient Only List is appealable under the Appeal of Factual (Non-Medical Necessity) Determinations.

  • Denial of payment by the State WIC Agency or payment of a claim by the vendor for a vendor violation(s) shall not absolve the vendor of the violation(s).

  • Denial of payment for any new admis- sion to a skilled nursing facility (SNF), inter- mediate care facility (ICF) or ICF/mentally retarded (MR) that no longer meets the appli- cable conditions of participation (for SNFs) or standards (for ICFs and ICF/MRs) if the facility’s deficiencies do not pose immediate jeopardy to patients’ health and safety.

Related to Denial of payment

  • Denial of Service Attack means an attack intended by the perpetrator to overwhelm the capacity of a "computer system" by sending an excessive volume of electronic data to such "computer system" in order to prevent authorized access to such "computer system".

  • Tariff Payment means the payments to be made under Monthly Bills as referred to in Article 10 and the relevant Supplementary Bills;

  • Proof of payment means, as applicable, a copy of the check, confirmation of credit card or debit card payment, confirmation of wire or ACH transfer, and any other information required to demonstrate that payment has been made according to the EPA requirements, in the amount due, and identified with the Respondent’s name and Docket No. FIFRA-04-2021-0714(b).

  • Copayment means that you pay a fixed amount each time you fill a prescription.

  • Erroneous Payment Subrogation Rights has the meaning assigned to it in Section 10.14(d).

  • Denial means the process of refusing to grant a license after OCCL receives an application. This constitutes refusal of permission to operate.

  • Third Party Payment means payment through an instrument issued from a bank account other than that of the beneficiary investor. In case of payments from a joint bank account, the first named investor/holder of the mutual fund folio has to be one of the joint holders of the bank account from which payment is made.

  • Registered Health Practitioner means a health practitioner registered, or licensed, as a health practitioner (or as a health practitioner of a particular type) under a law of a State or Territory that provides for the registration or licensing of health practitioners (or health practitioners of that type).

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • Third Party Administrator (TPA means any organization or institution that is licensed by the IRDA as a TPA and is engaged by the Company for a fee or remuneration for providing Policy and claims facilitation services to the Insured / Insured Person as well as to the Company for an insurable event.

  • School of cosmetology means an establishment operated for the purpose of teaching cosmetology.

  • Participating Certified Nurse Practitioner means a Certified Nurse Practitioner who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Essential Health Benefits means, under section 1302(b) of the Patient Protection and Affordable Care Act, those health benefits to include at least the following general categories and the items and services covered within the categories: ambulatory patient services; Emergency Services; hospitalization; maternity and newborn care; mental health and substance abuse disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services and chronic disease management; and pediatric services, including oral and vision care.

  • Basic health plan means the plan described under chapter

  • Qualifying exigency means a situation where the eligible employee seeks leave for one or more of the following reasons:

  • Public health emergency means an emergency with respect to COVID–19 declared by a Federal, State, or local authority.

  • Advanced registered nurse practitioner or “ARNP” means a person who is currently licensed as a registered nurse under Iowa Code chapter 152 or chapter 152E who is licensed by the board as an advanced registered nurse practitioner.

  • Debit Payment means a particular transaction where a debit is made.

  • Date of Payment means the date on which NYSERDA requisitions a check from its statutory fiscal agent, the Department of Taxation and Finance, to make a Payment.

  • Guaranty of Payment means each Guaranty of Payment executed and delivered on or after the Closing Date in connection with this Agreement by the Guarantors of Payment, as the same may from time to time be amended, restated or otherwise modified.

  • Registered patient means a patient who is included in a list that is a registered patient list for the purposes of the Primary Medical Services (Sale of Goodwill and Restrictions on Sub- contracting) Regulations 2004(e);

  • Certified nurse practitioner means an ARNP educated in the disciplines of nursing who has advanced knowledge of nursing, physical and psychosocial assessment, appropriate interventions, and management of health care, and who possesses evidence of current certification by a national professional nursing association approved by the board.

  • Licensure means the status of a licensee when OCCL issued a child care license when the applicant demonstrated compliance with these regulations and applicable codes, regulations, and laws.

  • Cash assistance means cash benefits provided under the family independence program, the refugee assistance program, or state disability assistance.

  • Medicaid Notification of Termination Requirements Any Contractor accessing payments for services under the Global Commitment to Health Waiver and Medicaid programs who terminates their practice will follow the Department of Vermont Health Access, Managed Care Organization enrollee notification requirements.

  • Housing assistance means appropriate referrals by the