(a) Basis and scope. This section implements section 1932(f) of the Act by specifying the rules and exceptions for prompt payment of claims by MCOs.
(b) Definitions. ``Claim'' and ``clean claim'' have the meaning given those terms in Sec. 447.45.
(c) Contract requirements--(1) Basic rule. A contract with an MCO must provide that the organization will meet the requirements of Sec. 447.45(d)(2) and (d)(3), and abide by the specifications of Sec. 447.45(d)(5) and (d)(6).
(1) Basic rule. A contract with an MCO must provide that the organization will meet the requirements of Sec. 447.45(d)(2) and (d)(3), and abide by the specifications of Sec. 447.45(d)(5) and (d)(6).
(2) Exception. The MCO and its providers may, by mutual agreement, establish an alternative payment schedule.
(3) Alternative schedule. Any alternative schedule must be stipulated in the contract. [67 FR 41115, June 14, 2002]
Medicaid Premiums and Cost Sharing
Source: 78 FR 42307, July 15, 2013, unless otherwise noted.