Fraud and Abuse Report. Quarterly No Contractor shall provide a summary report of referrals made and program integrity activities conducted in the previous quarter. Recipient Verification Procedure Initially, annually and as revised Yes Contractor shall submit Contractor’s plan for verifying with Enrollees whether services billed by Providers were received, as required by 42 CFR 455.20, for Prior Approval. Contractor shall not be required to submit format changes for Prior Approval, provided there is no material change in information conveyed. This does not need to be provided to the Department separately by population. Recipient Verification Results Annually and within ten (10) Business Days after the Department’s request No Contractor shall submit a summary of the results of the Recipient Verification Procedure.
Appears in 2 contracts
Sources: Contract for Furnishing Health Services by a Managed Care Organization, Contract for Furnishing Health Services by a Managed Care Organization