Third Party Payors A. Except as provided in this Grant Agreement, Grantee shall screen all clients and may not bill the System Agency for services eligible for reimbursement from third party payors, who are any person or entity who has the legal responsibility for paying for all or part of the services provided, including commercial health or liability insurance carriers, Medicaid, or other federal, state, local and private funding sources.
B. As applicable, the Grantee shall:
i. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement that may be covered by those programs and bill those programs for the covered services;
ii. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third party payor, to receive services and bill the System Agency for the deductible;
iv. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. Xxxx all third party payors for services provided under this Grant Agreement before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Billing and Collection Customers BellSouth currently has in effect numerous billing and collection agreements with various interexchange carriers and billing clearing houses and as such these billing and collection customers (“B&C Customers”) query BellSouth’s LIDB to determine whether to accept various billing options from End Users. Until such time as BellSouth implements in its LIDB and its supporting systems the means to differentiate Lightyear’s data from BellSouth’s data, the following shall apply:
(1) Lightyear will accept responsibility for telecommunications services billed by BellSouth for its B&C Customers for Lightyear’s End User accounts which are resident in LIDB pursuant to this Agreement. Lightyear authorizes BellSouth to place such charges on Lightyear’s xxxx from BellSouth and shall pay all such charges, including, but are not limited to, collect and third number calls.
(2) Charges for such services shall appear on a separate BellSouth xxxx xxxx identified with the name of the B&C Customers for which BellSouth is billing the charge.
(3) Lightyear shall have the responsibility to render a billing statement to its End Users for these charges, but Lightyear shall pay BellSouth for the charges billed regardless of whether Lightyear collects from Lightyear’s End Users.
(4) BellSouth shall have no obligation to become involved in any disputes between Lightyear and B&C Customers. BellSouth will not issue adjustments for charges billed on behalf of any B&C Customer to Lightyear. It shall be the responsibility of Lightyear and the B&C Customers to negotiate and arrange for any appropriate adjustments.
Child Care Expenses (a) Where an employee is requested or required by the Employer to attend:
(i) Employer endorsed education, training and career development activities, or
(ii) Employer sponsored activities which are not included in the normal duties of the employee's job, and are outside their headquarters or geographic location, such that the employee incurs additional child care expenses, the employee shall be reimbursed for the additional child care expenses up to $60 per day upon production of a receipt.
(b) Where an employee, who is not on leave of absence, attends a course approved by the Employer outside the employee's normal scheduled work day such that the employee incurs additional child care expenses, the employee shall be reimbursed for the additional child care expense up to $30 per day upon production of a receipt. This reimbursement shall not exceed 15 days per calendar year.
(c) Reimbursement in (a) or (b) shall only apply where no one else at the employee's home can provide the child care.
(d) The receipt shall be a signed statement including the date(s), the hourly rate charged, the hours of care provided and shall identify the caregiver/agency.
Billing and Collection On behalf of and for the account of ---------------------- Provider, Service Company shall establish and maintain credit and billing and collection policies and procedures, and shall exercise reasonable efforts to xxxx and collect in a timely manner all professional and other fees for all billable Dental Care provided by Dental Care Professionals, including any such fees paid directly to Provider by Service Company pursuant to the then-current Membership Agreement (or similar agreement for providing professional services to dental plans) between Service Company and Provider. Service Company shall advise and consult with Provider regarding the fees for Dental Care provided by Provider (including any related discounting policy); it being understood, however, that Provider's consent shall be necessary to establish the fees (subject to (S)3.2(d), above) to be charged for Dental Care. In connection with the billing and collection services to be provided hereunder, Provider hereby grants to Service Company, throughout the Term (and thereafter as provided in (S)8.3), an exclusive special power of attorney and appoints Service Company as Provider's exclusive true and lawful agent and attorney-in-fact, and Service Company hereby accepts such special power of attorney and appointment, for the following purposes:
(a) To xxxx Provider's patients, in either Provider's or Service Company's name (as Service Company deems appropriate) and on Provider's behalf, for all billable Dental Care provided by or on behalf of Provider to patients.
(b) To xxxx, in either Provider's or Service Company's name (as Service Company deems appropriate) and on Provider's behalf, all claims for reimbursement or indemnification from insurance companies and plans, all state or federally funded dental benefit plans, and all other third party payors or fiscal intermediaries for all covered billable Dental Care provided by or on behalf of Provider to patients.
(c) To collect and receive, in either Provider's or Service Company's name (as Service Company deems appropriate) and on Provider's behalf, all accounts receivable generated by such xxxxxxxx and claims for reimbursement, to administer such accounts including, but not limited to, extending the time of payment of any such accounts for cash, credit or otherwise; discharging or releasing the obligors of any such accounts; suing, assigning or selling at a discount such accounts to collection agencies; or taking other measures to require the payment of any such accounts; provided, however, that extraordinary collection measures, such as filing lawsuits, discharging or releasing obligors shall not be undertaken without Provider Consent.
(d) To deposit all amounts collected into the Provider Account. Provider shall transfer and deliver to Service Company all funds received by Provider from patients or third party payors for Dental Care. Upon receipt by Service Company of any funds from patients or third party payors or from Provider for Dental Care pursuant to this agreement, Service Company shall promptly deposit the same into the Provider Account.
(e) To take possession of, endorse in the name of Provider, and deposit into the Provider Account any notes, checks, money orders, insurance payments, and any other instruments received in payment of accounts receivable for Dental Care.
(f) To sign checks, drafts, bank notes or other instruments on behalf of Provider, and to make withdrawals from the Provider Account for payments specified in this agreement and otherwise as agreed upon from time to time by the Parties. Upon request of Service Company, Provider shall execute and deliver to the financial institution at which the Provider Account is maintained such additional documents or instruments as Service Company may reasonably request to evidence or effect the special power of attorney granted to Service Company by Provider pursuant to this section and (S)4.12. The special power of attorney granted herein is coupled with an interest and shall be irrevocable except with Service Company's written consent. The irrevocable power of attorney shall expire when this agreement has been terminated, all accounts receivable purchased by Service Company pursuant to (S)7.7, if any, have been collected, and all amounts due to Service Company as described in Article VII have been paid.
Dues Receipts At the same time that Income Tax (T-4) slips are made available, the Employer shall type on the amount of union dues paid by each Union member in the previous year.
Billing Unless otherwise provided in the Grant Agreement, Grantee shall bill the System Agency in accordance with the Grant Agreement. Unless otherwise specified in the Grant Agreement, Grantee shall submit requests for reimbursement or payment monthly by the last business day of the month following the month in which expenses were incurred or services provided. Grantee shall maintain all documentation that substantiates invoices and make the documentation available to the System Agency upon request.
Chargebacks All Chargebacks are due upon presentation to Merchant. In the case of a failure to pay a Chargeback upon such presentment, in addition to any other remedies which may be exercised by Servicers, Merchant agrees to pay a late charge of one and one half percent (1.5%) per month or portion thereof, or the highest amount allowable by law, whichever is less, on all unpaid Chargebacks. Servicers are authorized to deduct the amount of any Chargebacks and fees from any settlement amounts due to Merchant or from the Reserve Account, if any, or collect by any other means, including by debit to Account. Merchant acknowledges and agrees that it is bound by the Rules with respect to any Chargeback. Merchant further acknowledges that it is solely responsible for providing Servicers with any available information to re-present a Chargeback and that, regardless of any information it provides or does not provide Servicers in connection with a Chargeback, or any other reason, Merchant shall be solely responsible for the liability related to such Chargeback. Merchant understands and agrees that Card transactions are subject to Chargeback for a variety of reasons under the Rules, or if Merchant has breached this Agreement, including without limitation, for the following reasons:
(a) The Sales Draft is illegible, not signed by the Cardholder or has not been presented to Servicers within the required time-frames.
(b) The Sales Draft does not contain the Imprint of a valid unexpired Card.
(c) A valid authorization number has not been correctly and legibly recorded on the Sales Draft.
(d) The Sales Draft is a duplicate of a prior Card transaction or is the result of two or more Card transactions generated for a single sale.
(e) The Cardholder alleges that he or she did not participate in the sale, authorize the use of the Card, receive goods or services purchased, or receive a required credit adjustment, or disputes the quality of the goods or services purchased.
(f) The price of goods or services on the Sales Draft differs from the amount which Merchant presents for payment.
(g) The Card transaction results from an Internet, mail, phone or preauthorized order and the Cardholder disputes entering into or authorizing the Card transaction or the Card transaction has been made on an expired or non-existing account number.
(h) Servicers reasonably believe in their discretion that Merchant has violated any provision of this Agreement.
(i) Servicers reasonably determine that the Card transaction is not bona fide or is subject to any claim of illegality, cancellation, rescission, or offset for any reason whatsoever, including without limitation, negligence, fraud or dishonesty on the part of Merchant or Merchant’s agents or employees.
(j) Merchant fails to provide a Sales Draft or legible copy thereof to Servicers in accordance with this Agreement.
(k) Merchant shall not initiate a Card transaction in an attempt to collect a Chargeback.
Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE
Gross Receipts The entire amount of all receipts, determined on a cash basis, from (a) tenant rentals collected pursuant to tenant leases of apartment units, for each month during the term hereof; provided that there shall be excluded from tenant rentals any tenant security deposits (except as provided below); (b) cleaning, tenant security and damage deposits forfeited by tenants in such period; (c) laundry and vending machines income; (d) any and all other receipts from the operation of the Project received and relating to the period in question; (e) proceeds from rental interruption insurance, but not any other insurance proceeds or proceeds from third-party damage claims, and (f) any other sums and charges collected in connection with termination of the tenant leases. Gross Receipts also does not include the proceeds of (i) any sale, exchange, refinancing, condemnation, or other disposition of all or any part of the Project, (ii) any loans to Owner whether or not secured by all or any part of the Project, (iii) any capital expenditures or funds deposited to cover costs of operations made by Owner, and (iv) any insurance policy (other than rental interruption insurance or proceeds from third-party damage claims).
CONTRACT CHARGES The Contract Charges for the Services shall be structured using any of the following pricing mechanisms (as may be agreed by the Parties and set out in an SOW); Capped Time and Materials; Price per Story; Time and Materials; Fixed Price (to be used only for Services that are ancillary to software development services); or using such other pricing mechanism or combination of pricing mechanism thereof as may be agreed by the Parties. In consideration of the Supplier’s performance of its obligations under this Contract and in consideration of the specific services that are set out in an applicable SOW, the Customer shall pay the undisputed Contract Charges in accordance with the relevant SOW for the Release and the payment provisions set out at Clause 14 (Payment and VAT). The Customer shall, in addition to the Contract Charges and following delivery by the Supplier of an Invoice, pay the Supplier a sum equal to the VAT chargeable on the value of the Services supplied in accordance with this Contract. If at any time during this Contract Period the Supplier reduces its framework Prices for any Services which are provided under the framework Agreement (whether or not such Services are offered in a catalogue (if any) which is provided under the framework Agreement) in accordance with the terms of the framework Agreement, the Supplier shall immediately reduce the Contract Charges for such Services under this Contract by the same amount. The Supplier shall in any event ensure that the Contract Charges are at all times compliant and consistent with the charging structure set out in framework Schedule 8 (Charging Structure) and do not exceed the prices set out therein. Contract Charges:
