Claims Processing and Administration Sample Clauses

Claims Processing and Administration. Manager shall be responsible for the development, implementation, and maintenance of such systems and procedures as may be reasonably directed by Physicians Care and as may be reasonably necessary for the appropriate review and timely payment or disapproval of all claims, with timing of such payments as directed by Physicians Care. Such system shall use claim forms as approved by Physicians Care and shall capture all information on such forms in the Manager's data base. Such systems and procedures shall be installed and operational no later than the earliest effective date of any Physicians Care Subscriber Agreement. Such system must provide electronic submission and payment of claims.
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Claims Processing and Administration. Heritage shall process claims for benefits incurred on or after the Effective Date of this Agreement. Processing shall be performed and claims shall be determined in accordance with the documents, policies, interpretations, rules, guidelines, and practices determined by the Company. The Company shall retain sole discretionary authority to make final determinations concerning eligibility and entitlement to benefits pursuant to any claim. Claims processing and administration task to be performed by Heritage shall include, but not be limited to: (i) receiving and evaluating completed claim forms from claimants, (ii) computing benefits under the applicable Plan under which the claim is made, (iii) providing basic claim information to the Company, Plan participants, and other beneficiaries, (iv) furnishing to claimants whose claims are denied or reduced the appropriate written notices setting forth the specific reason for denial or reduction and information and recourse as may be required by law; (v) consistently maintaining minimum service standards regarding the organization and maintenance of claim files and submitting questionable claims to the Company for prior authorization and approval; (vi) following the claims administration procedures and practices desired by the Company; (vii) verifying, when necessary and with the assistance of the Company, the eligibility of claimants to receive benefits under the Plan; (viii) determining, in accordance with the Plan and claim administration procedures and practices, the qualification of claims submitted and investigating the same as may be necessary, which investigation may include comprehensive subrogation and coordination of benefit reviews; (ix) providing recommendations to the Company regarding disputed claims for the Company’s ultimate determination; and (x) performing utilization review and case management services as outlined in the summary plan description or other applicable Plan Documents.
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Claims Processing and Administration. Both parties agree to either directly, or through a contract pharmacy benefits manager, process and administer claims at the point of sale for the retail network pharmacies and the beneficiaries in accordance with Benefit Program requirements and any applicable state or federal law.
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Claims Processing and Administration. Manager shall be responsible for the development, implementation, and maintenance of such systems and procedures as may be reasonably directed by Physicians Care and as may be necessary for the appropriate review and timely payment or disapproval of all claims, with timing of such payments as directed by Physicians Care. [Such system shall use claim forms as approved by Physicians Care and shall capture all information on such forms in the Manager's data base. The system must also accommodate multiple payment rates for a single service for a single provider and be capable of instituting multiple withholds for a single provider based on primary care physician affiliation with a particular risk unit. Such systems and procedures shall be installed and operational no later than the earliest effective date of any Physicians Care Subscriber Agreement. Such system must provide electronic submission and payment of claims.]
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Related to Claims Processing and Administration

  • COLLECTION AND ADMINISTRATION 42 5.1 Borrower's Loan Accounts ............................................................. 42 5.2 Statements ........................................................................... 42 5.3

  • Management and Administration 5.1 TxDOT Responsibility for Policy Decisions

  • Claims Processing BCBSM will process Provider's Clean Claims submitted in accordance with this Agreement in a timely fashion.

  • Financial, Accounting, and Administrative Services The Manager shall maintain the existence and records of the Corporation; maintain the registrations and qualifications of Fund Shares under federal and state law; monitor the financial, accounting, and administrative functions of the Fund; maintain liaison with the various agents employed by the Corporation (including the Corporation’s transfer agent, custodian, independent accountants and legal counsel) and assist in the coordination of their activities on behalf of the Fund.

  • FUND ADMINISTRATION SERVICES BNY Mellon shall provide the following fund administration services for each Fund, Series and class:  Calculate Fund approved income and per share amounts required for periodic distributions to be made by the applicable Fund, Series or class;  Coordinate a Fund’s annual audit and respond timely and completely to related requests;  Cooperate with each Fund’s independent auditors;  Supply various normal and customary portfolio and Fund statistical data as requested on an ongoing basis; and  If the chief executive officer or chief financial officer of a Fund is required to provide a certification as part of the Fund’s Form N-Q or Form N-CSR filing pursuant to regulations promulgated by the SEC under Section 302 of the Xxxxxxxx-Xxxxx Act of 2002, provide a sub-certification in support of certain matters set forth in the aforementioned certification. Such sub-certification is to be in such form and relating to such matters as reasonably agreed to by BNY Mellon in advance. BNY Mellon shall be required to provide the sub-certification only during the term of this Agreement with respect to the applicable Fund or Series and only if it receives such cooperation as it may request to perform its investigations with respect to the sub-certification. For clarity, the sub-certification is not itself a certification under the Xxxxxxxx-Xxxxx Act of 2002 or under any other law, rule or regulation. BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • Fund Administration ● Prepare annual and semi-annual financial statements ○ Utilizing templates for standard layout and printing ● Prepare Forms N-CEN, N-CSR and 24F-2 ● File Forms N-CEN and 24F-2 with the SEC ● Host annual audits ● Prepare required reports for quarterly Board meetings ● Monitor expense ratios ● Maintain budget vs. actual expenses ● Manage fund invoice approval and xxxx payment process ● Assist with placement of Fidelity Bond and E&O insurance ● Calculate monthly NAVs as required by the Trust and in conformance with generally accepted accounting principles (“GAAP”), SEC Regulation S-X (or any successor regulation) and the Internal Revenue Code ● Transmit net asset values to the advisor, NASDAQ, Transfer Agent & other third parties ● Reconcile cash & investment balances with the custodian ● Provide data and reports to support preparation of financial statements and filings ● Prepare required Fund Accounting records in accordance with the 1940 Act ● Obtain and apply security valuations as directed and determined by the Fund consistent with the Fund’s pricing and valuation policies ● Participate, when requested, in Fair Value Committee meetings as a non-voting member ● Calculate monthly SEC standardized total return performance figures ● Coordinate reporting to outside agencies including Morningstar, etc. ● Prepare and file Form N-PORT ● Coordinate annual update to prospectus and statement of additional information ● Coordinate standard layout and printing of prospectus ● Files Forms N-CSR and N-PX ● Coordinate EDGARization and filing of SEC documents ● Compile and distribute board materials (electronically) for quarterly board meetings ● Attend quarterly board meetings telephonically and prepare initial draft of meeting minutes ● Perform daily prospectus & SAI, SEC investment restriction monitoring ● Provide warning/Alert notification with supporting documentation ● Provide quarterly compliance testing certification to Board of Trustees ● Document Management/Sharing ● Initiate requests or provide feedback ● Retrieval of current and up to 15 months of historical reports ● Access to daily fund accounting data and static reports ● Portfolio compliance alerting with drill-down capability ● Portfolio data warehouse with reporting engine ● Investor data warehouse with ad hoc query builder ● Investor document image retrieval (i.e. correspondence, applications, checks) ● Trustee access that facilitates access to board materials and other relevant documents

  • Procurement Related Complaints and Administrative Review 49.1 The procedures for making a Procurement-related Complaint are as specified in the TDS. 49.2 A request for administrative review shall be made in the form provided under contract forms.

  • Management and Administrative Services The Investment Adviser shall perform, or arrange for its affiliates to perform, the management and administrative services necessary for the operation of the Fund, including administering shareholder accounts and handling shareholder relations. The Investment Adviser shall provide the Fund with office space, facilities, equipment and necessary personnel and such other services as the Investment Adviser, subject to review by the Board of Directors, from time to time shall determine to be necessary or useful to perform its obligations under this Agreement. The Investment Adviser, also on behalf of the Fund, shall conduct relations with custodians, depositories, transfer agents, pricing agents, dividend disbursing agents, other shareholder servicing agents, accountants, attorneys, underwriters, brokers and dealers, corporate fiduciaries, insurers, banks and such other persons in any such other capacity deemed to be necessary or desirable. The Investment Adviser generally shall monitor the Fund's compliance with investment policies and restrictions as set forth in filings made by the Fund under the federal securities laws. The Investment Adviser shall make reports to the Board of Directors of its performance of obligations hereunder and furnish advice and recommendations with respect to such other aspects of the business and affairs of the Fund as it shall determine to be desirable.

  • Payments for Distribution Assistance and Administrative Support Services (a) Payments to the Distributor. In consideration of the payments made by the Fund to the Distributor under this Plan, the Distributor shall provide administrative support services and distribution services to the Fund. Such services include distribution assistance and administrative support services rendered in connection with Shares (1) sold in purchase transactions, (2) issued in exchange for shares of another investment company for which the Distributor serves as distributor or sub-distributor, or (3) issued pursuant to a plan of reorganization to which the Fund is a party. If the Board believes that the Distributor may not be rendering appropriate distribution assistance or administrative support services in connection with the sale of Shares, then the Distributor, at the request of the Board, shall provide the Board with a written report or other information to verify that the Distributor is providing appropriate services in this regard. For such services, the Fund will make the following payments to the Distributor:

  • Minor and Administrative Errors A Competent Authority shall notify the Competent Authority of the other Party when the first-mentioned Competent Authority has reason to believe that administrative errors or other minor errors may have led to incorrect or incomplete information reporting or resulted in other infringements of this Agreement. The Competent Authority of such other Party shall apply its domestic law (including applicable penalties) to obtain corrected and/or complete information or to resolve other infringements of this Agreement.

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