Requirements for and Limitations for Billing of Claims, Documentation Requirements and Payments of Clean Claims Clause Samples

Requirements for and Limitations for Billing of Claims, Documentation Requirements and Payments of Clean Claims. Provider shall submit valid claims for each period in which BABHA authorized services are rendered under this Agreement. All Provider claims shall specify billable services hereunder. In order to be considered valid claims for which payments from BABHA may be made, Provider is required to bill for Services rendered to the consumers as soon as practical following the service delivery, or within ninety (90) days following the date of service, or within 90 days of receipt of the explanation of benefits (EOB) from the primary insurance. BABHA will work with Provider if extenuating circumstances should arise and claim submission exceeds the required 90 days from date of service. Detailed information regarding claims submission is set forth in the Provider Requirements. ▇▇▇▇▇ shall authorize and process service claims payments to the Provider within thirty (30) days following receipt of a complete and accurate billing statement from the Provider. All Services must be properly documented and supported by the appropriate clinical documentation written in each consumer’s medical record. Documentation supporting claims must comply with Provider Requirements and at a minimum must include date, start and stop time, contact type, attendance, location of service, description of service provided and signature of the staff providing the service. Insufficient, improper or undocumented services in the medical record will not be reimbursed by ▇▇▇▇▇ and may subject the Provider to reclamation/repayment. Upon request, Provider agrees to forward all appropriate clinical documentation supporting the delivery of Services to the agency holding the active, master medical record, within seven (7) calendar days of the provision of Services. The Provider’s submittal of valid claims for any service fees hereunder shall constitute Provider’s verification that the required services and service documentation have been completed, in compliance with the reimbursement requirements of BABHA, the MDHHS, Medicaid, and/or third party reimbursers and is on file currently. If the Provider’s services and service documentation are not in compliance with the reimbursement requirements of BABHA, the MDHHS, Medicaid, and/or third party reimbursers, the Provider shall not be paid and/or shall return payment(s) received from BABHA in such instances.
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