Claim Adjustments. PHARMACY shall electronically adjust all credits, duplicate claims, returned, and unclaimed prescriptions within ten
Claim Adjustments. Each Party shall inform the other within sixty (60) days after discovery of any Overpayment or any underpayment and both parties shall take prompt and effective measures to remedy such Overpayment or underpayment. A Party may recover an Overpayment or underpayment in accordance with this Agreement, Policies and Procedures and Law. If TrueCare determines that an Overpayment has been made to Provider, TrueCare will notify Provider of such Overpayment and the Provider shall refund any amounts due within thirty (30) days. If Provider does not remit payment to TrueCare within thirty (30) days, TrueCare may off-set such payment against future Claim payments owed to Provider by TrueCare to the extent permitted by applicable Law. If Provider disagrees with any determination by TrueCare that Provider has received an Overpayment, Provider shall have the right to appeal such determination as provided in Policies and Procedures; however, such appeal shall not suspend TrueCare’s right to recover the Overpayment during the appeals process, unless otherwise prohibited by Law.
Claim Adjustments. PHARMACY shall electronically adjust all credits, duplicate claims, returned, and unclaimed prescriptions within ten (10) business days after the original fill date. This includes, but is not limited to, reversals, and re-submittals for “return to stock” or partial fills, where the Covered Medication is partially filled and the remainder is not retrieved by the Member in a reasonable period of time, in which case PHARMACY must electronically reverse and resubmit the actual quantity of the Covered Medication received by the Member.
Claim Adjustments. TPA shall perform all adjustments, refunding and payment of prescribed bonuses, if any, to Participating Provider physicians on a quarterly basis; provided, however, that no such adjustments shall be made or bonuses paid from Patient's Choice Regional IPA distribution pools for the first 12 months during which the Plan is operative. In connection with such quarterly adjustments and payments, TPA shall provide to Patient's Choice and each Regional IPA a profile of Participating Providers utilization relative to other Participating Providers within a Regional IPA and of each Regional IPAs utilization relative to the other Regional IPAs.
