Common use of Service Verification Clause in Contracts

Service Verification. (A) The Contractor shall have policies and procedures to verify that services billed by Providers were received by the Contractor’s Enrollees. The Contractor’s written policies and procedures must include the following: (1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the state fiscal year for service verification; and (2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes: (i) the Enrollee’s name and Medicaid ID number; (ii) the date of each contact (if a prior attempt was unsuccessful); (iii) the method of contact; (iv) whether the Enrollee responded to the contact; and (v) whether the Enrollee indicated he or she obtained the service; (3) the Contractor shall keep copies of correspondence. (B) By November 1st of each year, the Contractor shall submit a report to the Department, in a Department specified format, documenting that service verifications were performed.

Service Verification. (A) The Contractor shall have policies and procedures to verify that services billed by Providers were received by the Contractor’s Enrollees. The Contractor’s written policies and procedures must include the following: (1) annually, the Contractor shall randomly select a minimum of 50 individual Enrollees who received a Covered Service during the state fiscal year for service verification; and; (2) the Contractor shall keep a record of each Enrollee contacted for service verification that includes: (i) the Enrollee’s name and Medicaid ID number; (ii) the date of each contact (if a prior attempt was unsuccessful); (iii) the method of contact; (iv) whether the Enrollee responded to the contact; and (v) whether the Enrollee indicated he or she obtained the service;; and (3) the Contractor shall keep copies of correspondence. (B) By November 1st of each year, the Contractor shall submit a report to the Department, in a Department specified format, documenting that service verifications were performed.