Medicaid integrity program definition

Medicaid integrity program. (MIP), means the program established in
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Examples of Medicaid integrity program in a sentence

  • However, during 2007 and 2008, that State also administered its own Medicaid integrity program, which recovered $28.9 million.Identified Overpayments Yielded a Negative Return on InvestmentThe National Medicaid Audit Program did not identify overpayments commensurate with the investment CMS made in the program.

  • Additionally, Section 6402 of the Patient Protection and Affordable Care Act (PPACA) provides guidance related to the Medicaid integrity program, health care fraud oversight and guidance, suspension of Medicaid payments pending investigation of credible allegations of fraud, and the increased funding associated with targeting and preventing Medicaid fraud, waste, and abuse.

  • The phase of ϵ is determined by long-distance physics, ϵ = 1 ei$c sin φє arg( M12/Γ12), where φє = arctan 2∆mK/∆ΓK 43.5◦.

  • Since this review function has historically been the exclusive purview of the states, the MIP is designed to provide an additional level of review beyond the established state Medicaid integrity program efforts.

  • The CONTRACTOR shall comply with all State and federal requirements regarding Fraud, Waste and Abuse, including but not limited to, Sections 1128, 1156, 1902(a)(68), and Section 1903(i) of the Social Security Act and the CMS Medicaid integrity program.

  • Some of the organizations overseeing rules and laws that apply to staff and leaders include the Occupational Health and Safety Administration, the U.S. Equal Employment Opportunity Commission, Medicare and Medicaid integrity program, State and Federal labor laws, State and Federal Building codes, and practice rules for licensed, certified and registered professionals.

  • Upon enactment of the DRA, the Center for Medicaid and State Operations administered the Medicaid integrity program within CMS.

  • Standards for IPTV are crucial to tap market potential and global audience.

  • Additionally, Section 6402 of the Patient Protection and Affordable Care Act (Affordable Care Act) provides guidance related to the Medicaid integrity program; health care fraud oversight and guidance; suspension of Medicaid payments pending investigation of credible allegations of fraud; and the increased funding associated with targeting and preventing Medicaid fraud, waste, and abuse.

  • Medicaid integrity program, program integrity review annual summary.

Related to Medicaid integrity program

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicaid program means the medical assistance

  • HMO means health maintenance organization.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • TRICARE means, collectively, a program of medical benefits covering former and active members of the uniformed services and certain of their dependents, financed and administered by the United States Departments of Defense, Health and Human Services and Transportation, and all laws applicable to such programs.

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • HCFA means the United States Health Care Financing Administration and any successor thereto.

  • Medicare Advantage The Medicare managed care options that are authorized under Title XVIII as specified at Part C and 42 C.F.R. § 422.

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Advance health care directive means a power of attorney for health care or a record signed or authorized by a prospective donor containing the prospective donor’s direction concerning a health care decision for the prospective donor.

  • Home Health Care Agency means an agency or organization which provides a program of home health care and which:

  • Government Apprenticeship Programme “ means training which is funded by the Government via the National Apprenticeship Service.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Database Management System (“DBMS”) is a computer process used to store, sort, manipulate and update the data required to provide Selective Routing and ALI.

  • PREVENTIVE CARE SERVICES means covered healthcare services performed to prevent the occurrence of disease as defined by the Affordable Care Act (ACA). See Preventive Care and Early Detection Services in Section 3. PRIMARY CARE PROVIDER (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Child Care Program means a person or business that offers child care.

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Safety Management System has the meaning given to it in the ISM Code.

  • Procurement Plan means the Recipient’s procurement plan for the Project, dated April 2, 2010, and referred to in paragraph 1.16 of the Procurement Guidelines and paragraph 1.24 of the Consultant Guidelines, as the same shall be updated from time to time in accordance with the provisions of said paragraphs.

  • Formulary means a list of covered prescription drugs provided under this plan. The formulary includes generic, preferred brand name, non-preferred brand name, and specialty prescription drugs.