Claims Processing Services. (a) PBM shall process Claims in real time consistent with applicable law, including ERISA and any other applicable state or federal law.
Claims Processing Services. I. TT agrees to edit and process detailed demographic, insurance, and provider information to process all claims. TT will submit all claims within three (3) business days of receipt of completed claim information, allowing time to process cancellations.
Claims Processing Services a. PBM shall perform administrative services for Employer, including but not limited to, processing Claims with a Claims Incurred Date indicated in Section 1 of Exhibit A for Covered Prescription Services in accordance with the Pharmacy Benefit Plan. PBM will pay, on Employer's behalf, only Claims that are:
Claims Processing Services. A. The Claims Processor is empowered and required to act with respect to the Program only as expressly stated in the CPA Agreement and in this Agreement. The Claims Processor's role shall be limited to that of claims processor under the Program, and the services rendered by the Claims Processor under this Agreement and the CPA Agreement shall not include the power to exercise control over the Employer’s Plan assets, if any, or otherwise, be deemed to be the "Plan Administrator" or a "Fiduciary" with respect to the Program. The Claims Processor is not a “Covered Entity” under the Health Insurance Portability and Accountability Act of 1996 as amended and has an executed Business Associate Agreement with APBA.
Claims Processing Services. Any intimation of claim and receipt of claim papers by the respective Underwriting Office of the Insurer shall be forwarded to the Regional Processing Office of the TPA on the same day. The claims processing service provided by the TPA along with the responsibilities of the TPA as detailed in the clauses 10, 11 and 12 read with Schedules I to IV is collectively referred to as the "CPP Service".
Claims Processing Services. I. The Provider agrees to provide to TT detailed information on all current patients being seen by the Provider who have an outstanding balance with TT. The Provider further understands that such detailed information is required in order for TT to carry out its responsibilities under this Contract. The Provider understands that obtaining this information is the Providers responsibility. This information must be posted, in full, to TT’s Application.
Claims Processing Services. MiliRisk shall provide claims processing services for and on behalf of Millers Mutual and Millers Casualty which shall include, but shall not be limited to:
Claims Processing Services. PBM shall provide the following Claims processing services related to prescriptions dispensed on or after the Effective Date.
Claims Processing Services. ProAct shall provide Claims processing services related to Claims for prescriptions dispensed on or after the Effective Date of this Agreement. ProAct shall process Claims received from Participating Pharmacies and Plan Participants, determine whether such Claims qualify for reimbursement in accordance with the terms of the applicable Benefit Plan and determine the applicable payment. ProAct agrees to process Claims within National Council for Prescription Drug Programs (NCPDP) prevailing standards. ProAct shall process Claims within the time frames established by applicable state and federal law. Upon termination of this Agreement, ProAct shall be obligated to process only those Claims which are for prescriptions dispensed before the termination date and which are received by ProAct within ninety (90) days of the termination date. Any Claims submitted and processed after the termination date will be invoiced at the rates set forth for such Claims in Exhibit A. ProAct shall arrange for the following services to be provided upon receipt of a Claim:
Claims Processing Services mean eligibility determination and verification efforts prior to processing claims for prescriptions dispensed for Eligible Members in accordance with the terms of the Plan Design Document within the standards adopted under the Health Insurance Portability and Accountability Act of 1996 Regulations for Electronic Transactions.
