Claims Management. The Retrocessionaire agrees to take any and all actions necessary or appropriate for the management of claims arising under the Reinsurance Agreements, including without limitation investigating, assessing, adjusting, arbitrating, litigating and settling claims, as appropriate, and shall conduct itself with the utmost good faith in taking such actions. The Retrocessionaire is hereby authorized and directed to undertake all such actions on behalf of the Retrocedent.
Claims Management. 13.1. The Management Venture will alert as to potential claims expected to be received from contractors, suppliers, the Concessionaire and any other agent involved in the Project. The alerts will be documented in monthly reports that will be submitted to the Company.
13.2. The Management Venture will manage, handle, advise to and assist in legal and quasi-legal proceedings that the Company will handle and/or in which the Company will be engaged in connection with the Project, inter alia in relation to contractors, consultants and/or in relation to any third party that was involved in the Project. In the framework of the above, the Management Venture will be required to be well familiar with the provisions of all the relevant legal and engineering documents in such proceedings, provide affidavits, attend legal proceedings and quasi-legal proceedings for the purpose of providing testimonies, participate in preliminary hearings and preliminary discussions to such legal proceedings and quasi-legal proceedings as well as provide expert opinions and provide testimonies as may be necessary until the end of the relevant statute of limitations period in connection with such claims.
13.3. The Management Venture will provide preliminary assessment pertaining to any claim that will be received from the designer of the Project, contractors, consultants and so forth in terms of cost, time expenditure, implications for the Project and the chances of the claim to succeed, and will provide recommendations as to the course of action relating to the claim.
13.4. The Management Venture will prepare a periodic report as to claims status.
13.5. The Company may order the Management Venture and the Management Team Members, as it may decide, to provide to it assistance in legal proceedings, including providing testimony and an opinion in the field of expertise, recovery of information and issues that will arise during the provision of the Services, analysis of claims and so forth, this for a period not exceeding seven (7) years after the completion of Project Stage “7”.
13.6. The Basic Services Consideration (as defined in Appendix A to the Agreement), includes the entire consideration for providing counsel to claims through the period until the end of the first two (2) years after the completion of Project Stage “7”, and the Management Venture will not be entitled to any additional consideration for such counsel to claims. The Basic Services Consideration does not include counsel...
Claims Management by deleting the term “Medicaid claims” as well as any reference thereto and replacing it with the phrase “Medicaid and Demonstration claims”. (Demonstration claims will be processed as all other Medicaid claims are processed.)
Claims Management. A. Assist the City with contractor claims by endeavoring to identify areas of potential risk during design reviews, preparation of bid packages and as construction progresses.
B. Attempt to resolve claims in accordance with the dispute resolution plan. The analysis, negotiation and resolution of claims beyond the procedures in the dispute resolution plan, including any services related to mediation, arbitration, litigation or other form of dispute resolution are an Additional Service that can be provided upon request.
Claims Management. The Consultant shall develop systems for management and avoidance of claims and disputes, and assist the County in resolution of claims and disputes.
Claims Management. Provider shall not require any co-payments, recipient pay amounts, or other cost sharing arrangements unless specifically authorized by state or federal regulations and/or policies. Provider may not xxxx individuals for the difference between the Provider’s charge and BABHA’s payment for services. Provider shall not seek nor accept additional supplemental payment from the individual, his/her family, or representative, for services authorized by BABHA. Provider shall not hold a Medicaid enrollee liable for any costs, charges, fees or other liabilities in the event that BABHA becomes insolvent, for which payment is not made by BABHA, the State, or other authorized payer, or for which Provider has not or will not be paid by BABHA, the State or other authorized payor.
Claims Management. All EHCPs shall be obliged to submit their claims within 24 hours of discharge in the format prescribed. However, in case of Public EHCPs this time may be relaxed as defined by SHA. The SHA (recommended by ISA) / Insurer shall be responsible for settling all claims within 15 days after receiving all the required information/ documents. Member may bring the following to the AB PM-XXX helpdesk: Letter from MoHFW/NHA RSBY Card Any other defined document as prescribed by the State Government Arogya Mitra/Operator will check if AB PM-XXX e-Card/ AB PM-XXX ID/ Aadhaar Number is available with the beneficiary In case Internet connectivity is available at hospital Operator/Arogya Mitra identifies the beneficiary’s eligibility and verification status from AB PM-XXX Central Server If beneficiary is eligible and verified under AB PM-XXX, server will show the details of the members of the family with photo of each verified member If found OK then beneficiary can be registered for getting the cashless treatment. If patient is eligible but not verified then patient will be asked to produce Aadhaar Card/Number/ Ration Card for verification (in absence of Aadhaar) Beneficiary mobile number will be captured. If Aadhaar Card/Number is available and authenticated online then patient will be verified under scheme (as prescribed by the software) and will be issued a AB PM-XXX e-Card for getting the cashless treatment. Beneficiary gender and year of birth will be captured with Aadhaar eKYC or Ration Card If Aadhaar Card/Number is not available then beneficiary will advised to get the Aadhaar Card/number within stipulated time. In case Internet connectivity is not available at hospital Arogya Mitra at AB PM-XXX Registration Desk at Hospital will call Central Helpline and using IVRS enters AB PM-XXX ID or Aadhaar number of the patient. IVRS will speak out the details of all beneficiaries in the family and hospital will choose the beneficiary who has come for treatment. It will also inform the verification status of the beneficiary If eligible and verified then beneficiary will be registered for getting treatment by sending an OTP on the mobile number of the beneficiary In case beneficiary is eligible but not verified then she/he can be verified using Aadhaar OTP authentication and can get registered for getting cashless treatment In case of emergency or in case person does not show AB PM-XXX e-Card/ID or Aadhaar Card/Number and claims to be AB PM-XXX beneficiary and show some pho...
Claims Management. XXX will serve a supervisory function and will monitor the progress of all claims, including requesting and reviewing reports from counsel, until claims are resolved or the limits are paid. NAS’ responsibilities include:
1. Retaining defense counsel, as appropriate;
2. Retaining coverage counsel, as appropriate;
3. Requesting periodic claim updates, litigation budgets, liability assessments, and settlement recommendations;
4. Liaising with supervising/coverage counsel and/or defense counsel (or vendors) regarding status of claims, with focus on prompt handling and early resolution, if and when possible;
5. Authorizing settlements and the engagement of experts or vendors;
Claims Management a. All EHCPs shall be obliged to submit their claims within 24 hours of discharge in the format prescribed. However, in case of Public EHCPs this time may be relaxed as defined by SHA.
b. The SHA (recommended by ISA) / Insurer shall be responsible for settling all claims within 15 daysafter receiving all the required information/ documents.
Claims Management. 1. Investigating causation to determine if a claim is compensable (AOE/XXX) including but not limited to review of documents (5020, DFR, supervisor’s report, etc.); assignment of investigator, review of investigator’s report(s), medical evaluation(s); or any other investigation necessary
2. Analyzing of appropriate charges including review of medical bills, associated reports and payment log to assure billing and treatment are appropriate and associated with claim; referral to xxxx review and utilization review, as appropriate;
3. Issuing all required notifications including all benefit notices, forms and letters;
4. Issuing timely benefits which have been accurately calculated;
5. Updating case reserves;
6. Referring and managing of rehabilitation benefits and efforts;
7. Negotiating and Settling of claims either directly with injured workers or with applicant attorneys in cases where an injured worker is represented including the preparation and processing of all associated paperwork
8. Communicating both written and oral with City departments, claimants, medical providers, attorneys, and staff of the WCD of City’s Department of Human Resources (“DHR”)
