Definitions Related to the Provision of Covered Services. Provider shall follow the State Contract’s requirements for the provision of Covered Services. Provider’s decisions affecting the delivery of acute or chronic care services to Covered Persons shall be made on an individualized basis and in accordance with the following definitions: (a) Clean Claim: A claim submitted in accordance with 42 C.F.R. 447.45, as amended from time to time, that can be processed without obtaining additional information from the provider of the service or from a third party. It includes a claim with errors originating in a State’s claims system. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity.
Appears in 5 contracts
Sources: Kansas Medicaid and Chip Regulatory Requirements Appendix, Kansas Medicaid and Chip Regulatory Requirements Appendix, Individual Participating Provider Agreement