Provider Claims definition
Examples of Provider Claims in a sentence
Provider Claim(s) – Any bill, invoice, or statement from a specific Provider for Health Care Services or supplies provided to Enrollees.
The primary functions of the Provider Claims Educator are to: • Educate contracted and non-contracted Providers regarding appropriate Claims submission requirements, coding updates, electronic Claims transactions and electronic fund transfer, and available PH-MCO resources such as Provider manuals, website, fee schedules, etc.
The customer shall furnish bare or insulated copper wire in his service entrance as a bond between the equipment ground and NBU's common neutral system.
The Contractor shall administer an effective, accurate and efficient claims processing function that adjudicates and settles Provider Claims for Covered Services that are filed within the time frames specified by DCH (see Part I.
Provider Claim(s) – Any bill, invoice, or statement from a specific Provider for Covered Services or supplies provided to Enrollees.
The MCO must submit the Provider Claims Dispute Report to ODM as specified in Appendix P, Chart of Deliverables, including but not limited to information regarding number and types of disputes by provider type, resolution time, identified trends, and program improvements.
The Contractor may challenge any sanctions imposed by CPSA in accordance with the ADHS/DBHS/CPSA Provider Manual Section 5.6, Provider Claims Disputes.
The CHC-MCO’s MIS must be bidirectionally linked to the other operational systems listed in this agreement, in order that data captured in Encounter records accurately matches data in Participant, Provider, Claims and authorization files, and in order to enable Encounter Data to be utilized for Participant profiling, Provider profiling, Claims validation, Fraud and Abuse monitoring activities, rate setting and any other research and reporting purposes defined by the Department.
The PH-MCO must have at a minimum the following components to its MIS or the capability to link to other systems containing this information: Membership, Provider, Claims processing, Prior Authorization, Reference.
Calculation methodology is outlined in the following diagram: The following outlines the minimum percentage of Provider Claims that must be associated with a VBP payment arrangement for each contract year.