Payment Hold definition
Payment Hold means that payments to be made in good faith for services rendered will be put on hold during the period of an investigation/forensic audit which has no predetermined length of time in days.
Payment Hold. [(3) "Hold on payment"] means the
Payment Hold means the temporary denial of reimbursement under Medicaid for items or services furnished by a specified provider.
More Definitions of Payment Hold
Payment Hold. [(3) "Hold on payment"] means the temporary denial of reimbursement under the Medicaid program for items or services furnished by a specified provider.
Payment Hold. The situation when a Provider who owes funds to Puerto Rico, such Provider cannot be paid until the amounts owed to Puerto Rico are repaid or an acceptable repayment plan is in place, as determined by ASES. Pharmacy: Any person, institution, corporation or any other business entity duly licensed by the Government under Act No. 247 of September 3, 2004, as amended, to dispense prescription drugs. Pharmacy Call Center: A call center facility established by the Contractor to provide Information through a local toll-free telephone access to Pharmacies offering Covered Pharmacy Services to Enrollees. Pharmacy Complaints and Appeal Process: The overall system that Contractor must have to address any complaints, grievances, and appeals of Network Pharmacies, as well as access to the Administrative Law Hearing process. Pharmacy Contract: The written agreements to be entered into by the Contractor and Network Pharmacies forming part of the Pharmacy Network, as required under this Contract. Pharmacy Financial Committee: Committee authorized by ASES to make formulary recommendations and include in the Formulary of Medications Covered (FMC) or List of Medication by Exception (LME) selections based on the drug review and recommendations of the P&T Committee to include or exclude prescription drugs. Pharmacy Network: The Network Pharmacies contracted by the Contractor to provide Covered Pharmacy Services under the terms and conditions of this Contract to Enrollees. Pharmacy and Therapeutics (“P&T”) Committee: A multi-disciplinary, multi-specialty committee authorized by ASES consisting of independent health care professionals that provides advice regarding the efficacy and safety of prescription drugs. Physician Administered Drug (“PAD”): An outpatient drug other than a vaccine that is typically administered by a health care provider in a physician’s office or other outpatient clinical setting Primary Medical Group (“PMG”): A grouping of associated Primary Care Physicians and other Providers for the delivery of services to GHP Enrollees using a coordinated care model. PMGs may be organized as Provider care organizations, or as another group of Providers who have contractually agreed to offer a coordinated care model to GHP Enrollees under the terms of this Contract. Prior Authorization: Authorization granted by the Contractor to determine whether the service is Medically Necessary. In some instances, this process is a condition for receiving the Covered Pharmacy Service...
Payment Hold means the temporary
Payment Hold. The situation when a Provider who owes funds to Puerto Rico, such Provider cannot be paid until the amounts owed to Puerto Rico are repaid or an acceptable repayment plan is in place, as determined by ASES.
Payment Hold means the temporary denial of