Erroneous claims definition
Erroneous claims means pharmacy claims submitted in error, including, but not limited to, unintended, incorrect, fraudulent, or test claims.
Erroneous claims means Pre-Determination Requests and Claims: (i) determined by ClaimSecure through an Audit; or (ii) self-reported by the Pharmacy Provider, as being erroneous, including Claims determined to have been the subject of Fraud, Waste or Abuse, duplicate Claim payments, Claims with coding errors and/or overcharges, and Claims in respect of which there has been a lack of coordination of benefits.