[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR447.46]



[Page 313]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 447_PAYMENTS FOR SERVICES--Table of Contents

 

                 Subpart A_Payments: General Provisions

 

Sec.  447.46  Timely claims payment by MCOs.



    (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. Sec.  447.45(d)(2) and (d)(3), and abide by the specifications of 

Sec. 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]



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