Medicaid contractor definition

Medicaid contractor means an entity that, under a contract with or otherwise on behalf of HHSC, performs one or more administrative services in relation to HHSC’s operation of a part of the State Medicaid program, such as claims processing, utilization review, client enrollment, provider enrollment, quality monitoring, or payment of claims. The independent auditor will deliver to the CONTRACTOR and to HHSC a report of the findings and recommendations within 30 calendar days of the close of each audit. The report will be prepared in accordance with generally accepted auditing standards.
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Examples of Medicaid contractor in a sentence

  • The Medicaid laws, regulations, and program instructions are available through the Medicaid contractor.

  • For electronic payments, payment files are sent to the Medicaid contractor bank on Wednesday with an effective transfer date of Thursday.

  • Either Parent or the applicable Parent Subsidiary is a party to one or more valid agreements with CMS and/or any state Medicaid agency (with respect to states where Parent or such Parent Subsidiary so participates as a Medicaid contractor) authorizing its participation as a Program contractor under all applicable Laws.

  • Either the Company or the applicable Company Subsidiary is a party to one or more valid agreements with CMS and/or any state Medicaid agency (with respect to states where the Company or such Company Subsidiary so participates as a Medicaid contractor) authorizing its participation as a Program contractor under all applicable Laws.

  • If Contractor is a licensed provider with Medicare and/or Medicaid, contractor must first ▇▇▇▇ these payers and receive a written denial before UPCAP Services can pay.

  • If, at any time, the Tribes identify or learn of an overpayment, the Tribes shall repay the overpayment to the appropriate payor (e.g., Medicare or Medicaid contractor) within 60 days after identification of the overpayment and take steps to correct the problem and prevent the overpayment from recurring within 90 days after identification (or such additional time as may be agreed to by the payor).

  • Each party represents that it is not under investigation or has not been disqualified as a Medicare or Medicaid contractor and agrees to notify the other party if such investigation should occur relating to or arising from the services provided for by this Agreement.

  • The Remainder of the Settlement Amount shall not be decreased as a result of the denial of claims for payment now being withheld from payment by the Alaska Medicaid program or any Medicaid contractor related to the Covered Conduct; and Respondent agrees not to resubmit to any Alaska payor any previously denied claims related to the Covered Conduct, agrees not to appeal any such denials of claims, and agrees to withdraw any such pending appeals.

  • OIG, in its sole discretion, may refer the findings of the Claims Review Sample (and any related work papers) received from PFH to the appropriate Medicare contractor, state Medicaid contractor or state Medicaid managed care organization program contractor for appropriate follow up by the payor.

  • These training requirements may be satisfied only by training courses that are submitted to OIG, prior to registration for the training course, for review and approval, and may include courses provided by the Centers for Medicare & Medicaid Services (CMS) Medicare Learning Network (MLN), or the Providers’ Medicare or Medicaid contractor (including, but not limited to, any Medicare managed care organization to which the Providers submit claims), if they fulfill the requirements below.