(1) As used in this subchapter:(1) “Audit” means an investigation or review of a claim submitted by a healthcare provider if the investigation or review:(A) Is conducted by an auditor; and(B) Involves records, documents, or information other than the filed claim;(2) “Auditor” means:(A) An insurance company;(B) A third-party payor; or(C) An entity that represents a responsible party, including a company or group that administers claims services;(3) (A) “Clerical or recordkeeping error” means a mistake in the filed claim regarding a required document or record.(B) “Clerical or recordkeeping error” includes without limitation:(i) A typographical error;(ii) A scrivener's error; or(iii) A computer error; and(4) (A) “Healthcare provider” means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer healthcare services.(B) “Healthcare provider” does not include a pharmacy that is subject to § 17-92-1201.
(1) “Audit” means an investigation or review of a claim submitted by a healthcare provider if the investigation or review:(A) Is conducted by an auditor; and(B) Involves records, documents, or information other than the filed claim;
(A) Is conducted by an auditor; and
(B) Involves records, documents, or information other than the filed claim;
(2) “Auditor” means:(A) An insurance company;(B) A third-party payor; or(C) An entity that represents a responsible party, including a company or group that administers claims services;
(A) An insurance company;
(B) A third-party payor; or
(C) An entity that represents a responsible party, including a company or group that administers claims services;
(3) (A) “Clerical or recordkeeping error” means a mistake in the filed claim regarding a required document or record.(B) “Clerical or recordkeeping error” includes without limitation:(i) A typographical error;(ii) A scrivener's error; or(iii) A computer error; and
(A) “Clerical or recordkeeping error” means a mistake in the filed claim regarding a required document or record.
(B) “Clerical or recordkeeping error” includes without limitation:(i) A typographical error;(ii) A scrivener's error; or(iii) A computer error; and
(i) A typographical error;
(ii) A scrivener's error; or
(iii) A computer error; and
(4) (A) “Healthcare provider” means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer healthcare services.(B) “Healthcare provider” does not include a pharmacy that is subject to § 17-92-1201.
(A) “Healthcare provider” means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer healthcare services.
(B) “Healthcare provider” does not include a pharmacy that is subject to § 17-92-1201.