Common use of DELAY IN SERVICE Clause in Contracts

DELAY IN SERVICE. If United determines that Participating Facility did not execute a physician’s written order in a timely manner and that, as a result, the Customer’s inpatient stay was lengthened, United may deny the claims with regard to the bed day(s) at the end of the stay that would not have been needed were it not for the delay in service (including room, board and other services for the given day), and process the claim based on the contract rate that would apply without that day(s); Participating Facility will not seek or collect payment from Customer in excess of the coinsurance, copayment or deductible associated with the claim as processed. United will not reduce payment under this subsection 1.9(vi) when the contract rate for a claim is not impacted by the length of stay, because the contract rate is determined by an MS-DRG or similar methodology and is not subject to an inpatient outlier provision.

DELAY IN SERVICE. If United determines that Participating Facility did not execute a physician’s written order (for instance, an admission order) in a timely manner and that, as a result, the Customer’s inpatient stay was lengthened, United may deny the claims with regard to the bed day(s) at the end of the stay that would not have been needed were it not for the delay in service (including room, board and other services for the given day), and process the claim based on the contract rate that would apply without that day(s); Participating Facility will not seek or collect payment from Customer in excess of the coinsurance, copayment or deductible associated with the claim as processed. United will not reduce payment under this subsection 1.9(vi6.5(A)(vi) when the contract rate for a claim is not impacted by the length of stay, because the contract rate is determined by an MS-DRG or similar methodology and is not subject to an inpatient outlier provision.