Billing and Reimbursement. 1. It is the Contractor’s responsibility to verify the Enrollee’s Medicaid coverage prior to submitting claims to the LME/PIHP. If an individual presents for services who is not eligible for Medicaid and the Contractor reasonably believes that the individual meets Medicaid financial eligibility requirements, Contractor shall offer to assist the individual in applying for Medicaid.
2. The LME/PIHP may unilaterally revise reimbursement rates under this Contract with 30 days’ notice.
3. Contractor shall comply with all terms of this Contract even though a third party agent may be involved in billing the claims to the LME/PIHP. It is a material breach of the Contract to assign the right to payment under this Contract to a third party in violation of Controlling Authority, specifically 42 C.F.R. §447.10.
4. Contractor acknowledges that the LME/PIHP and this Contract covers only those Medicaid- reimbursable, and state and/or federal block grant funded, MH/DD/SA services listed in Attachment A, and does not cover other services outlined in the North Carolina State Plan for
5. Contractor further understands that, regarding Medicaid services, there are circumstances that may cause an Enrollee to be disenrolled from or by the LME/PIHP. If the disenrollment arises from Enrollee’s loss of Medicaid eligibility, the LME/PIHP shall be responsible for claims for the Enrollee up to and including the Enrollee’s last day of eligibility. If the disenrollment arises from a change in the Enrollee’s Medicaid County of residence, LME/PIHP shall be responsible for claims for Enrollee up to the effective date of date of the change in Medicaid County of residence. In any instance of Enrollee’s disenrollment, preexisting authorizations will remain valid for any services actually rendered prior to the date of disenrollment.
6. Contractor shall xxxx LME/PIHP for all MH/DD/SA services as listed in Attachment A.
7. Unless otherwise indicated, LME/PIHP will pay the Contractor the lesser of the Contractor’s current usual and customary charges or the LME/PIHP established rate for services.
Billing and Reimbursement. 1. It is the CONTRACTOR’s responsibility to verify the Enrollee’s Medicaid coverage prior to submitting claims to the LME/PIHP. If an individual presents for services who is not eligible for Medicaid and the CONTRACTOR reasonably believes that the individual meets Medicaid financial eligibility requirements, CONTRACTOR shall offer to assist the Enrollee in applying for Medicaid.
2. The LME/PIHP Medicaid reimbursement rate can be revised unilaterally by the Department at any time. Should these rates change during the Contract period, the LME/PIHP may seek to negotiate a change in the payment rate.
3. CONTRACTOR shall comply with all terms of this Contract even though a third party agent may be involved in billing the claims to the LME/PIHP. It is a breach of the Contract to assign the right to payment under this Contract to a third party in violation of Controlling Authority, specifically 42
4. CONTRACTOR acknowledges that the LME/PIHP and this Contract covers only those Medicaid- reimbursable MH/DD/SA services listed in Appendix F, and does not cover other services outlined in the North Carolina State Plan for Medical Assistance. The CONTRACTOR may xxxx any such other services for Medicaid recipients directly to the North Carolina Medicaid program.
5. CONTRACTOR further understands that there are circumstances that may cause an Enrollee to be dis-enrolled from or by the LME/PIHP. If the disenrollment arises from Enrollee’s loss of Medicaid eligibility, the LME/PIHP shall be responsible for claims for the Enrollee up to and including the Enrollee’s last day of eligibility. If the disenrollment arises from a change in the Enrollee’s Medicaid county of residence, LME/PIHP shall be responsible for claims for Enrollee up to the effective date of date of the change in Medicaid county of residence. In any instance of Enrollee’s disenrollment, preexisting authorizations will remain valid for any services actually rendered prior to the date of disenrollment.
6. CONTRACTOR shall xxxx LME/PIHP for all MH/DD/SA services as listed in Appendix F provided to Enrollees who reside in the LME/ PIHP catchment area.
7. LME/PIHP will pay the CONTRACTOR the lesser of the CONTRACTOR’s current usual and customary charges or the LME/PIHP established rate for services.
Billing and Reimbursement. These Policies and Procedures shall be designed to ensure that Parkland complies with the Federal health care programs requirements on billing and reimbursement, shall be implemented within 90 days after the Effective Date, and shall include the following:
i. ensuring the proper and accurate preparation and submission of claims to Federal health care programs;
ii. ensuring the proper and accurate documentation of medical records;
iii. ensuring the proper and accurate submission of cost reports submitted to the Federal health care programs;
iv. conducting periodic billing and coding reviews and audits at Parkland; and
v. reporting and repayment of all identified Overpayments to Federal health care programs and other payors.
Billing and Reimbursement. HOMELINK shall pay Provider for services according to the condition and terms described in Exhibit B. In no event shall Provider xxxx, charge, collect a deposit from, seek compensation, remuneration or reimbursement fro or have any recourse against patients or any persons other than HOMELINK or any applicable third party payer for services provided pursuant to this Agreement.
Billing and Reimbursement. With respect to each prescription filled by PROVANTAGE, AMS shall pay PROVANTAGE the charges set forth in the Data Sheet attached hereto or the applicable Plan Parameters plus any applicable state or federal sales or use taxes.
Billing and Reimbursement. These policies and procedures shall be designed to ensure that Txxxx complies with the Federal health care programs requirements on billing and reimbursement, and shall include the following:
(i) ensuring the proper and accurate preparation and submission of claims to Federal health care programs;
(ii) ensuring the proper and accurate documentation of medical records;
(iii) ensuring the proper and accurate submission of cost reports submitted to the Federal health care programs;
(iv) conducting periodic billing and coding reviews and audits at Txxxx hospitals;
(v) ensuring that each Txxxx hospital has an established charge structure which is applied uniformly to each patient as services are furnished to the patient and which is reasonably and consistently related to the cost of providing services (consistent with the Provider Reimbursement Manual);
(vi) monitoring all changes to the chargemasters at Txxxx hospitals to ensure review and approval by appropriate Txxxx personnel; and
(vii) reporting and repayment of all identified Overpayments to Federal health care programs and other payors.
Billing and Reimbursement. 6.1 Chronimed will, as an element of its patient intake process, attempt to identify insurance or other drug benefits coverage for Enrolled Patients. Chronimed will coordinate, on behalf of Enrolled Patients, benefit claims submission to procure reimbursement for Fuzeon. Chronimed will seek reimbursement for Fuzeon from Enrolled Patients and their insurers according to individual patient benefits plan design. Except as specifically stated in this Agreement, or otherwise waived in writing by Chronimed on a case-by-case basis, nothing herein shall prohibit or restrict Chronimed's right to seek or collect patient co-payments, co-insurance, or other personal obligations to pay for Fuzeon orders, in whole or in part, on or after the date of shipment.
6.2 In the event an Enrolled Patient lacks sufficient benefits coverage, coverage is denied by an Enrolled Patient's insurance carrier, an Enrolled Patient does not qualify for or receive governmental drug benefits, or an Enrolled Patient is otherwise unable to pay for Fuzeon treatment, then Chronimed will refer such Enrolled Patient to Roche, or its currently designated vendor for further evaluation and possible admission to the Patient Assistance Program.
6.3 Chronimed reserves the right to terminate services to any Enrolled Patients, upon prior notice to and consultation with Roche, for whom Chronimed has been unable to obtain payment, including benefits claims, co-payments, coinsurance, deductibles, or other payment obligations, for more than 60 days after the date of service generating the payment obligation.
6.4 In the event an Enrolled Patient is entitled to benefits under a non-Medicaid, government funded or subsidized program such as Xxxx Xxxxx, ADAP, PHS pricing, or the VA system, Chronimed will facilitate and document such patient's Fuzeon distribution and pricing sufficient to submit appropriate credits to Roche, pursuant to the terms and procedures identified in EXHIBIT E, TRANSACTION ADJUSTMENTS.
Billing and Reimbursement. With respect to each prescription filled by PROVANTAGE, AMS shall pay PROVANTAGE the charges set forth in the Data Sheet attached hereto or the applicable Plan Parameters plus any applicable state or federal sales or use taxes. In the event a Plan Participant submits to PROVANTAGE a copayment in an insufficient amount, and PROVANTAGE is unable to collect the correct copayment amount from the Participant, then PROVANTAGE reserves the right to invoice AMS for the amount of the uncollected copayment(s). All payments shall be made to PROVANTAGE in accordance with Section 11 of this Agreement.
Billing and Reimbursement. Medically Home shall pay Provider for services, equipment and supplies in accordance with the fee schedule depicted on Exhibit B, attached hereto and incorporated herein. Provider is to xxxx Medically Home within thirty (30) days of service. Medically Home will send payment to Provider within 45 days after Medically Home receives Provider’s invoice.
Billing and Reimbursement. 4.1 Each Ride DuPage to Work Partner will be responsible for paying Pace one hundred percent (100%) of its monthly costs, which is based on monthly ridership, upon receipt of a monthly Ride DuPage to Work invoice from Pace. Each Partner will be solely responsible for the payment(s) described above. No Partner shall be responsible for another Partner’s payment obligations for the Ride DuPage to Work Program unless agreed to in writing through a separate agreement.
4.2 Each Partner shall promptly send the City of Naperville a copy of every monthly invoice from Pace for the Ride DuPage to Work Program. Said invoice shall reflect the one hundred percent (100%) payment made to Pace, and the fifty percent (50%) amount to be reimbursed through the Section 5310 Enhanced Mobility of Seniors and Individuals with Disabilities grant. At the same time that the Partner provides the City with the Pace invoices described above, each Partner shall also provide the City with supporting documentation, including but not limited to ridership data, as determined to be appropriate by the City.
4.3 The City of Naperville will maintain and update a collective tracking sheet for each of the Ride DuPage to Work Partners indicating the number of trips, the 100% payment, and the fifty percent (50%) reimbursement. The total reimbursement to the Ride DuPage to Work Partners over the grant period shall not exceed a total of $372,026 cumulatively, as to all Partners. The City of Naperville will submit a requisition form to the RTA, along with supporting documents, requesting reimbursement for Ride DuPage to Work trips that are eligible for reimbursement for each Partner. The eligible trips for each Ride DuPage to Work Partner will be determined by taking fifty percent (50%) of the total monthly invoice from Pace for the Ride DuPage to Work Program. The City of Naperville will accept the total monthly reimbursement from the RTA on behalf of the Ride DuPage to Work Partners, and provide each Partner with reimbursement for their eligible trips within thirty (30) days of receipt of the funds from the RTA so long as there are grant funds available. In the event that a reimbursement request submitted by the City as set forth in Section 4.3 above on behalf of any Partner is either not received from the RTA, or is not approved by the RTA, for any reason, the City shall not be liable or responsible for such payment as set forth in Section 6 below.
4.4 Prior to receiving reimbursement hereunder, ea...
