Billing Members. Group agrees to include language in its Agreement with Physicians/Providers that requires that Physicians/Providers not seek reimbursement from Plan's Medicare Members for services rendered to them under or in the course of this Agreement. Should the contracts with CMS be terminated or expire, payment for all services performed for eligible Medicare Members prior to termination will be guaranteed by Plan.
Billing Members. For BadgerCare Plus and Medicaid SSI any provider who knowingly and willfully bills a BadgerCare Plus and Medicaid SSI member for a covered service shall be guilty of a felony and upon conviction shall be fined, imprisoned, or both, as defined in Section 1128B.(d)(1) [42 U.S.C. 1320a-7b] of the Social Security Act and Wis. Stats. 49.49(3m). This provision shall continue to be in effect even if the HMO becomes insolvent. However, if a member agrees in advance in writing to pay for a service not covered by BadgerCare Plus and/or Medicaid SSI, then the HMO, HMO provider, or HMO subcontractor may xxxx the member. The standard release form signed by the member at the time of services does not relieve the HMO and its providers and subcontractors from the prohibition against billing a member in the absence of a knowing assumption of liability for a non-BadgerCare Plus and/or Medicaid SSI covered service. The form or other type of acknowledgment relevant to a member’s liability must specifically state the admissions, services, or procedures that are not covered by BadgerCare Plus and/or Medicaid SSI. The HMO and its providers and subcontractors must not xxxx a BadgerCare Plus- or Medicaid SSI member for medically necessary covered services provided during the member’s period of HMO enrollment, except for allowable co- payments and premiums established by the Division of Health Care Access and Accountability (DHCAA) for covered services provided during the member’s period of enrollment in BadgerCare Plus-Standard and Benchmark Plans. The HMO and its providers and subcontractors may not xxxx a Medicaid SSI member for co-payments and/or premiums for medically necessary services provided during the member’s period of HMO enrollment.
Billing Members. Participant may xxxx or charge Members only (1) those amounts detailed in the Amplifon Materials, and (2) for Hearing Services and Products that are not covered by the Members’ Plan (“Non-Covered Services”). Prior to rendering Non-Covered Services, Participant shall obtain a written agreement from the Member that the Member will be solely liable for payment of the Non-covered Services. Participant shall not xxxx or charge Members or Amplifon for Covered Services that the Participant does not normally charge for.
Billing Members. BadgerCare Plus programs must comply with ForwardHealth policy regarding the 5% cost share cap for enrolled members, as required under Sections 1916A(a)(2)(B), 1916A(b)(1)(B)(ii), and 1916A(b)(2)(A) of the Social Security Act, as implemented in 42 CFR §447.56(f)). If the County elects to charge copays to members, they must provide at least a 6 month notice to DHS and submit a member communication plan for approval before implementation.
Billing Members. For the FCMH Program, any provider who knowingly and willfully bills a member for a covered service shall be guilty of a felony and upon conviction shall be fined, imprisoned, or both as defined in Section 1128B(d)(1) [42 U.S.C. 1320a- 7b] of the Social Security Act and Wis. Stats. 49.49(3m). This provision shall continue to be in effect even if the PIHP becomes insolvent. However, if a member agrees in advance in writing to pay for a service not covered by Medicaid, then the PIHP, PIHP provider, or PIHP subcontractor may xxxx the member. The standard release form signed by the member at the time of services does not relieve the PIHP and its providers and subcontractors from the prohibition against billing a member in the absence of a knowing assumption of liability for a Medicaid non-covered service. The form or other type of acknowledgment relevant to a member’s liability must specifically state the admissions, services, or procedures that are not covered by Medicaid. The PIHP and its providers and subcontractors must not xxxx a FCMH member for medically necessary covered services or for co-payments during the member’s period of PIHP enrollment in the FCMH Program.
Billing Members. MSO and MSO Provider agree to not seek reimbursement from the Health Plan's Medicare Members for services rendered to them under or in the course of this Agreerrient. Should the contract with CMS be terminated or expire, payment for all services performed for eligible Medicare Members prior to termination will be guaranteed by the Health Plan. MSO and MSO Provider shall indemnify and hold CMS harmless, pursuant to the provisions of section 3.12 of the Agreement, and from any costs, including legal fees, relating to improper billing practices or consequential effects caused by breach of the terms of this Agreement.
Billing Members. Participant may xxxx or charge Members only those amounts detailed in the HHC Resource Manual.
