Common use of COLLECTION OF CHARGES FROM Clause in Contracts

COLLECTION OF CHARGES FROM. THIRD PARTIES WHEN MEDICARE NOT THE PRIMARY PAYOR - IPA and Member Physicians accept payment from PacifiCare (plus applicable Copayments) for Medical Services as provided herein as full payment for such Medical Services from PacifiCare except as provided herein; provided however, when Medicare is not the primary payor for Medical Services, such as when the Subscriber is entitled to payment from another third party or for payment for a Workers' Compensation claim, or from other primary insurance coverage maintained by Subscriber, IPA and Member Physicians shall make no demand upon PacifiCare for reimbursement under the Individual Subscriber Stop Loss Program as specified in Attachment A3 hereto until all primary sources of payment have been pursued and it is determined that full payment cannot be obtained within the (10) months from the date of the provision of Medical Services. For purposes of accomplishing the intent of this Section 3.08, PacifiCare hereby assigns to IPA for collection, any claims or demands against third parties for amounts due for Medical Services provided by IPA pursuant to this Agreement, subject to the following conditions: 3.08.01 IPA shall not commence any legal or equitable action against a third party without obtaining the prior written consent of PacifiCare. It is agreed that collection or demand letters consistent with the PacifiCare Provider Policies and Procedures Manual shall not constitute the commencement of legal or equitable action. 3.08.02 IPA shall defend, indemnify and hold PacifiCare harmless for all actions by IPA which relate to collections of an account pursuant to this Section 3.08. 3.08.03 IPA shall perform such collection activities consistent with the procedures set forth in the PacifiCare Provider Policies and Procedures Manual. 3.08.04 PacifiCare may immediately rescind such assignment on a claim-by-claim basis for any reason by providing written notice of recision to IPA. In the event IPA receives payment from a third party after receipt of payment from PacifiCare, IPA shall reimburse PacifiCare to the extent that the combined amounts received from all payors exceeds one hundred percent (100%) of IPA's usual and customary fee-for-service charges.

COLLECTION OF CHARGES FROM. THIRD PARTIES WHEN MEDICARE NOT THE PRIMARY PAYOR - IPA and Member Physicians accept payment from PacifiCare (plus applicable Copayments) for Medical Services as provided herein as full payment for such Medical Services from PacifiCare except as provided herein; provided however, when Medicare is not the primary payor for Medical Services, such as when the Subscriber is entitled to payment from another third party or for payment for a Workers' Compensation claim, or from other another primary insurance coverage maintained by Subscriber, IPA and Member Physicians shall make no demand upon PacifiCare for reimbursement under the Individual Subscriber Stop Loss Program as specified in Attachment A3 hereto until all primary sources of payment have been pursued and it is determined that full payment cannot be obtained within the ten (10) months from the date of the provision of Medical Services. For purposes of accomplishing the intent of this the Section 3.08, PacifiCare hereby assigns to IPA for collection, any claims or demands against third parties for amounts due for Medical Services provided by IPA pursuant to this Agreement, subject to the following conditions: 3.08.01 IPA shall utilize lien forms which are provided by PacifiCare in the PacifiCare Policies and Procedures Manual or which have been approved in advance by PacifiCare. IPA shall notify PacifiCare each time it pursues and each time it obtains a signed lien from a Subscriber. 3.08.02 IPA shall not commence any legal or equitable action against a third party without obtaining the prior written consent of PacifiCare. It is agreed that collection or demand letters consistent with the PacifiCare Provider Policies and Procedures Manual shall not constitute the commencement of legal or equitable action. Under no circumstances, shall IPA commence any legal action against a Subscriber. 3.08.02 3.08.03 IPA shall defend, indemnify and hold PacifiCare harmless for all actions by IPA which relate to collections of an account pursuant to this Section 3.08. 3.08.03 3.08.04 IPA shall perform such collection activities consistent with the procedures set forth in the PacifiCare Provider Policies and Procedures Manual. 3.08.04 3.08.05 PacifiCare may immediately rescind such assignment on a claim-by-claim basis for any reason by providing written notice of recision rescission to IPA. In the event IPA receives payment from a third party after receipt of payment from PacifiCare, IPA shall reimburse PacifiCare to the extent that the combined amounts received from all payors exceeds one hundred percent (100%) [ ** ] of IPA's usual and customary fee-for-service charges.

COLLECTION OF CHARGES FROM. THIRD PARTIES WHEN MEDICARE NOT THE PRIMARY PAYOR - IPA and Member Physicians accept payment from PacifiCare (plus applicable Copayments) for Medical Services as provided herein as full payment for such Medical Services from PacifiCare except as provided hereinServices; provided however, when Medicare is not in the primary payor for Medical Services, such as when event the Subscriber is entitled to payment from another third party or for payment for a Workers' Compensation claim, or from other primary insurance coverage maintained by Subscriber, IPA and Member Physicians shall make no demand upon PacifiCare for reimbursement under the Individual Subscriber Stop Loss Program as specified in Attachment A3 hereto until all primary sources of payment have been pursued and it is determined that full payment cannot be obtained within the ten (10) months from the date of the provision of Medical Services. For purposes of accomplishing the intent of this Section 3.08subsection, PacifiCare hereby assigns to IPA for collection, any claims or demands against third parties for amounts due for Medical Services provided by IPA pursuant to this Agreement, subject to the following conditions: 3.08.01 IPA shall utilize lien forms which are provided by PacifiCare in the PacifiCare Policies and Procedures Manual or which have been approved in advance by PacifiCare. IPA shall notify PacifiCare each time it pursues and each time it obtains a signed lien from a Subscriber. 3.08.02 IPA shall not commence any legal or equitable action against a third party without obtaining the prior written consent of PacifiCare. It is agreed that collection or demand letters consistent with the PacifiCare Provider Policies and Procedures Manual shall not constitute the commencement of legal or equitable action. Under no circumstances, shall IPA commence any legal action against a Subscriber. 3.08.02 3.08.03 IPA shall defend, indemnify and hold PacifiCare harmless for or all actions by IPA which relate to collections of an account pursuant to this Section 3.08. 3.08.03 3.08.04 IPA shall perform such collection activities consistent with the procedures set forth in the PacifiCare Provider Policies and Procedures Manual. 3.08.04 3.08.05 PacifiCare may immediately rescind such assignment in total or on a claim-by-claim basis for any reason by providing written notice of recision rescission to IPA. In the event IPA receives payment from a third party after receipt of payment from PacifiCare, IPA shall reimburse PacifiCare to the extent that the combined amounts received from all payors exceeds one hundred percent (100%) of IPA's usual and customary fee-for-service charges.

COLLECTION OF CHARGES FROM. THIRD PARTIES WHEN MEDICARE NOT THE PRIMARY PAYOR - IPA and Member Physicians accept payment from PacifiCare (plus applicable Copayments) for Medical Services as provided herein as full payment for such Medical Services from PacifiCare except as provided hereinServices; provided however, when Medicare is not in the primary payor for Medical Services, such as when event the Subscriber is entitled to payment from another third party or for payment for a Workers' Compensation claim, or from other primary insurance coverage maintained by Subscriber, IPA and Member Physicians shall make no demand upon PacifiCare for reimbursement under the Individual Subscriber Stop Loss Program as specified in Attachment A3 hereto until all primary sources of payment have been pursued and it is determined that full payment cannot be obtained within the ten (10) months from the date of the provision of Medical Services. For purposes of accomplishing the intent of this Section 3.08subsection, PacifiCare hereby assigns to IPA for collection, any claims or demands against third parties for amounts due for Medical Services provided by IPA pursuant to this Agreement, subject to the following conditions: 3.08.01 IPA shall utilize lien forms which are provided by PacifiCare in the PacifiCare Policies and Procedures Manual or which have been approved in advance by PacifiCare. IPA shall notify PacifiCare each time it pursues and each time it obtains a signed lien from a Subscriber. 3.08.02 IPA shall not commence any legal or equitable action against a third party without obtaining the prior written consent of PacifiCare. It is agreed that collection or demand letters consistent with the PacifiCare Provider Policies and Procedures Manual shall not constitute the commencement of legal or equitable action. Under no circumstances shall IPA commence any legal action against a Subscriber to obtain payment for Health Care Services. 3.08.02 3.08.03 IPA shall defend, indemnify and hold PacifiCare harmless for all actions by IPA which relate to collections of an account pursuant to this Section 3.08. 3.08.03 3.08.04 IPA shall perform such collection activities consistent with the procedures set forth in the PacifiCare Provider Policies and Procedures Manual. 3.08.04 3.08.05 PacifiCare may immediately rescind such assignment in total or on a claim-by-claim basis for any reason by providing written notice of recision rescission to IPA. In the event IPA receives payment from a third party party, a workers' compensation carrier or a primary insurer after receipt of payment from PacifiCare, IPA shall reimburse PacifiCare to the extent that the combined amounts received from all payors exceeds one hundred percent (100%) [ ** ] of IPA's usual and customary fee-for-service charges.