applicable number of calendar days

(2) (A) Each contract under section 1395kk–1 of this title that provides for making payments under this part shall provide that payment shall be issued, mailed, or otherwise transmitted with respect to not less than 95 percent of all claims submitted under this part— (i) which are clean claims, and (ii) for which payment is not made on a periodic interim payment basis, within the applicable number of calendar days after the date on which the claim is received. (B) In this paragraph: (i) The term “clean claim” means a claim that has no defect or impropriety (including any lack of any required substantiating documentation) or particular circumstance requiring special treatment that prevents timely payment from being made on the claim under this part. (ii) The term “applicable number of calendar days” means— (I) with respect to claims received in the 12-month period beginning October 1, 1986 , 30 calendar days, (II) with respect to claims received in the 12-month period beginning October 1, 1987 , 26 calendar days (or 19 calendar days with respect to claims submitted by participating physicians), (III) with respect to claims received in the 12-month period beginning October 1, 1988 , 25 calendar days (or 18 calendar days with respect to claims submitted by participating physicians), (IV) with respect to claims received in the 12-month period beginning October 1, 1989 , and claims received in any succeeding 12-month period ending on or before September 30, 1993 , 24 calendar days (or 17 calendar days with respect to claims submitted by participating physicians), and (V) with respect to claims received in the 12-month period beginning October 1, 1993 , and claims received in any succeeding 12-month period, 30 calendar days. (C) If payment is not issued, mailed, or otherwise transmitted within the applicable number of calendar days (as defined in clause (ii) of subparagraph (B)) after a clean claim (as defined in clause (i) of such subparagraph) is received, interest shall be paid at the rate used for purposes of section 3902(a) of title 31 (relating to interest penalties for failure to make prompt payments) for the period beginning on the day after the required payment date and ending on the date on which payment is made.

Source

42 USC § 1395u(c)(2)


Scoping language

In this paragraph
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