Billing and Payment Information. XXX Xxxxx invoices are generated every quarter at the end of February, May, August and November. The invoice will be sent to your registered email addresses. The exact due date for payment will be clearly stated on the xxxx. However generally payments are expected 21 days after the date on which the xxxx was issued. Customers have the following options available for them to make their payment.
Billing and Payment Information. The Contractor shall:
a. Invoice Care Management services to the Department’s MMIS Contractor, HP, in accordance with Department procedures. Home and community based services and medical services provided to Clients are to be billed directly by the enrolled Medicaid provider in accordance with Department procedures.
b. Submit bills to the Department within the time specified for the filing of Medicaid claims of one year. Invoices for Care Management services shall be received within 12 months of the services being delivered or within 12 months of the date a Client is granted retroactive eligibility.
c. Invoice for Care Management services provided to each PCA Waiver Client. The Department shall reimburse on a two times per month financial cycle. The Department shall pay all valid and proper claims within 30 days after receipt of said claims. A valid and proper bill for services is one that has no defects and requires no additional information for processing.
d. Electronic claims are the preferred method of billing.
e. Submit HIPAA compliant electronic claims when the Contractor has the computer capability and when authorized in advance to do so by the Department. The Contractor shall follow all current HIPAA procedures including signed Trading Partner Agreement Reimbursements. The Contractor shall adhere to the Department’s Policies and Procedures relative to the Access Agency’s billing procedures to receive reimbursement for Care Management services performed.
Billing and Payment Information o Prepayment. It is your responsibility to ensure that your payment information is up to date, and that all payments are paid on time. You agree to pay for the Services in advance of the time period during which such Services are provided. Subject to applicable laws, rules, and regulations, payments received will be first applied to the oldest outstanding payments in your billing account.
Billing and Payment Information. Membership fees and dues do not include fees for seminars, testings, tournaments, and other services and products, which are charged separately. Fees are due regardless of classes unattended including illness and Acts of God.
Billing and Payment Information. Philips Lifeline will first bill you when your Equipment is shipped to you. You agree to pay the applicable fees for the Equipment and Service along with any sales tax, shipping and handling, enrollment fee, and any additional Philips Lifeline services you later order. Fees are subject to change upon 30 days’ prior written notice to Payer. Payment is due upon your receipt of an invoice. Past due balances (over 30 days) are subject to a monthly finance service charge of 18% percent per year, or the maximum allowable by law. If Philips Lifeline must institute legal proceedings to collect payments due, then you agree to pay Philips Lifeline’s reasonable attorney’s fees for such collection action unless prohibited by law. You agree to pay for a full month of service for any month in which you have Service. Philips Lifeline reserves the right to charge a fee for any replacement Equipment, including but not limited to a Personal Help Button, AutoAlert Help Button, or GoSafe Mobile Button; contact Philips Lifeline Customer Service to ask about current fees for replacement Equipment.
Billing and Payment Information. It is your responsibility to ensure that your payment information is up to date, and that all invoices are paid on time. You agree to pay for the Services in advance of the time period during which such Services are provided. Subject to applicable laws, rules, and regulations, payments received will be first applied to the oldest outstanding invoice in your billing account.
Billing and Payment Information. Company Information (please print the company name as you would prefer it to appear in acknowledgments, etc.)
Billing and Payment Information. Your program is not considered definite until Payment Information is received with the signed contract.
Billing and Payment Information. Person(s) responsible for bill: Mailing Address: Email: phone: I DO NOT want to set up recurring payments or Scheduled Invoicing I DO want to set up: (please mark one) recurring payments I would like to set up a recurring payment of $ , weekly, bi-weekly, monthly (Please circle one) scheduled invoicing I would like an invoice to be emailed to , weekly, bi-weekly, monthly (please circle one) If you circled weekly or bi weekly please state here the first day you would like to that to start / / (DD/MM/YYYY) If you circled monthly please state here what day of the month here / / (DD/MM/YYYY) I/we , as the person(s) stated above, agree that I/we I am responsible for tuition fees, as listed above. I understand and agree to the options stated and chosen. I agree to communicate any changes in a timely manner. Signature Date: Print name relationship: Signature Date: Print name relationship: Child’s Name: Date of Birth: Agreement Date: Start Date Classroom Parent/Guardian’s e(s): Parent(s) agree to the following: (Please initial each item)
