Claims Workflows Sample Clauses

Claims Workflows. Vendor shall determine the Claims Workflow appropriate for each Claim Assignment based on cause of loss, severity, and other eligibility directives that may be provided by Citizens. The Desk Adjuster shall oversee each Claim Assignment through the selected Claims Workflow. The eligibility directives for the Claims Workflow as of the Effective Date are provided below. Citizens may revise the directives for a Claims Workflow by providing written notice to Vendor. Citizens may also determine maximum Claim Assignment volume for all or certain Adjusters/Field Inspectors for a Claims Workflow. Citizens may require a specific Claims Workflow for a Claim Assignment regardless of general eligibility directives. Vendor shall use the following severity table in determining the Claims Workflow for residential claims: Severity 1 Minor Exterior Damage Only (No Interior Damage) – Any of the following: Damage to gutters, fences, sheds, pool/patio screen. Fallen trees that did not land on roof. Power outage or electrical/appliance damages. Severity 2 Minor Interior/Exterior Damage – Any of the following: Missing roof shingles, broken windows or skylights, damaged or missing siding, water stain on ceiling or wall in ONLY one room. Fallen tree on home that did not create a hole in the roof. Severity 3 Medium Interior/Exteriors Damage – Any of the following: Hole(s) in roof, walls, or siding from fallen tree, debris, or wind. Water stain on ceilings or walls in MORE THAN one room. Severity 4 Major Interior/Exterior Damage (Home is Still Livable) - Any of the following: Exposed framing is visible on roof or exterior walls due to wind, tree limbs, or fallen tree.
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Related to Claims Workflows

  • Claims Submission Unless otherwise prohibited by federal or state law, Provider will submit Clean Claims for all Covered Services to BCBSM within one hundred eighty (180) days of the date of service.

  • Paid Claims without Supporting Documentation Any Paid Claim for which Xxxxxxx cannot produce documentation shall be considered an error and the total reimbursement received by Xxxxxxx for such Paid Claim shall be deemed an Overpayment. Replacement sampling for Paid Claims with missing documentation is not permitted.

  • Protocols Each party hereby agrees that the inclusion of additional protocols may be required to make this Agreement specific. All such protocols shall be negotiated, determined and agreed upon by both parties hereto.

  • Submitting False Claims The full text of San Francisco Administrative Code Chapter 21, Section 21.35, including the enforcement and penalty provisions, is incorporated into this Agreement. Pursuant to San Francisco Administrative Code §21.35, any contractor or subcontractor who submits a false claim shall be liable to the City for the statutory penalties set forth in that section. A contractor or subcontractor will be deemed to have submitted a false claim to the City if the contractor or subcontractor: (a) knowingly presents or causes to be presented to an officer or employee of the City a false claim or request for payment or approval;

  • ODUF Packing Specifications 6.3.1 A pack will contain a minimum of one message record or a maximum of 99,999 message records plus a pack header record and a pack trailer record. One transmission can contain a maximum of 99 packs and a minimum of one pack.

  • Submitting False Claims; Monetary Penalties The AOC shall be entitled to remedy any false claims, as defined in California Government Code section 12650 et seq., made to the AOC by the Contractor or any Subcontractor under the standards set forth in Government Code section 12650 et seq. Any Contractor or Subcontractor who submits a false claim shall be liable to the AOC for three times the amount of damages that the AOC sustains because of the false claim. A Contractor or Subcontractor who submits a false claim shall also be liable to the AOC for (a) the costs, including attorney fees, of a civil action brought to recover any of those penalties or damages, and (b) a civil penalty of up to $10,000 for each false claim.

  • Training Materials Training Materials will be provided for each student. Training Materials may be used only for either (i) the individual student’s reference during Boeing provided training and for review thereafter or (ii) Customer’s provision of training to individuals directly employed by the Customer.

  • Security of All Software Components Supplier will inventory all software components (including open source software) used in Deliverables, and provide such inventory to Accenture upon request. Supplier will assess whether any such components have any security defects or vulnerabilities that could lead to a Security Incident. Supplier will perform such assessment prior to providing Accenture with access to such software components and on an on-going basis thereafter during the term of the Agreement. Supplier will promptly notify Accenture of any identified security defect or vulnerability and remediate same in a timely manner. Supplier will promptly notify Accenture of its remediation plan. If remediation is not feasible in a timely manner, Supplier will replace the subject software component with a component that is not affected by a security defect or vulnerability and that does not reduce the overall functionality of the Deliverable(s).

  • CLAIMS SUPPORT The Board shall complete and submit the Trust Plan Administrator’s Waiver of Life Insurance Premium Plan Administrator Statement to the Trust Plan Administrator for life waiver claims when the Trust Plan Administrator does not administer and adjudicate the LTD benefits.

  • Timeliness of Submitting Orders You are obliged to date and indicate the time of receipt of all orders you receive from your customers and to transmit promptly all orders to us in time to provide for processing at the price next determined after receipt by you, in accordance with the Prospectuses. You are not to withhold placing with us orders received from any customers for the purchase of shares. You shall not purchase shares through us except for the purpose of covering purchase orders already received by you, or for your bona fide investment.

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