Common use of Provider Payments Clause in Contracts

Provider Payments. (1) The MCO shall submit medical provider bills electronically to the Bureau within seven (7) Business Days from the MCO's provider bill Receipt Date. The Bureau shall review all bills for allowed conditions and allowed claims and shall pay the MCO for allowed payments after receipt of a proper invoice and after a final adjudication permitting payment for the claim. The Bureau shall make Electronic Fund Transfer ("EFT") to the MCO within seven (7) Business Days after receipt of a proper invoice and after a final adjudication permitting payment for the claim. The MCO shall pay the provider within seven (7) Business Days from receipt of the EFT. The MCO shall pay interest to the Bureau at the rate established by the Office of Budget and Management, if the provider is not paid within thirty (30) days of receipt of the EFT from the Bureau. (2) The MCO shall retrieve electronic bills from the Bureau's World Wide Web site (www.▇▇▇▇▇▇▇.▇▇▇) ▇▇ later than 5:00 P.M. the next Business Day after the bills are placed in the MCO's directory by the Bureau. (3) The MCO shall pay provider bills in accordance with Rules 4123-6-10, 4123-6-11, and 4123-6-12 of the Ohio Administrative Code. However, if the MCO utilizes a leased provider network to fulfill the requirements of Section 1B. of this Agreement, the MCO shall not apply the discounted payment rates of the leased network to its payments to any provider within that network without first obtaining the signed written consent of the provider. (4) Not later than March 1, 1999, the MCO shall have and use a system that tracks the status of provider bills at any stage of the bill adjudication process. Such a system must allow the MCO to respond to inquiries by authorized parties and to the Bureau as to the disposition of a bill ▇▇▇ the expected payment date of a bill. ▇▇e Bureau may require the MCO to issue reports to the Bureau and/or medical providers on the status of payments to providers. (5) The MCO shall educate providers, both in-state and out-of-state, on correct billing procedures and the MCO's prior authorization methods. (6) Following termination of this Agreement the Bureau shall reimburse the MCO for providers' services only if invoices are submitted within sixty (60) days of the termination date and only if such payment is not subject to deduction.