§ 20-77-1303 - Definitions. - Arkansas Statutes

20-77-1303. Definitions.

As used in this subchapter, the following terms shall have the following meanings:

(1) "Administrative adjudication" means adjudication and the adjudication process contained in the Arkansas Administrative Procedure Act, 25-15-201 et seq.;

(2) "Claim" includes any request or demand, including any and all documents or information required by federal or state law or by rule, made against medical assistance programs funds for payment. A claim may be based on costs or projected costs and includes any entry or omission in a cost report or similar document, book of account, or any other document which supports, or attempts to support, the claim. A claim may be made through electronic means if authorized by the Department of Human Services. Each claim may be treated as a separate claim or several claims may be combined to form one claim;

(3) "Department director" or "director" means the Director of the Department of Human Services;

(4) "Health care provider" means any person furnishing or claiming to furnish a good, service or supply under the medical assistance programs, any other person defined as a health care provider by federal or state law or rule, and a provider-in-fact;

(5) "Medical assistance programs" means the Medical Assistance Program, Title XIX of the Social Security Act, commonly referred to as "Medicaid", and other programs operated by and funded in the department which provide payment to persons or entities providing any good, service, or supply to a recipient;

(6) "Order" means a final order imposed pursuant to an administrative adjudication;

(7) "Payment" means the payment to a health care provider from medical assistance programs funds pursuant to a claim, or the attempt to seek payment for a claim;

(8) "Recoupment" means recovery through the reduction, in whole or in part, of payment to a health care provider;

(9) "Rule" means any rule or regulation promulgated by the department in accordance with the Arkansas Administrative Procedure Act, 25-15-201 et seq., and any federal rule or regulation promulgated by the federal government in accordance with federal law; and

(10) "Withhold payment" means to reduce or adjust the amount, in whole or in part, to be paid to a health care provider for a pending or future claim during the time of a criminal, civil, or departmental investigation or proceeding or claims review of the health care provider.