Compensation and Billing. 6.1 The Facility shall only seek payment from EGID for the provision of Covered Services. The Facility agrees to accept the amount of the Allowable Fee for Covered Services as payment in full and agrees to only request payment from the Member for deductible, co-insurance and amounts for defined Non-Covered Services attributable to the Member’s Health Choice Plan. The payment shall be calculated and limited to the methodologies defined by this Contract.
6.2 When the Allowable Fee exceeds billed charges, EGID shall pay the appropriate percentage of the Allowable Fee and Member shall pay the appropriate percentage of billed charges unless the Member has met the stop loss limitation and then EGID shall pay the Allowable Fee and the Member has no liability.
6.3 When processing inpatient claims, EGID shall determine the MS-DRG Allowable Fee for non- transfer cases according to the following formula: Skilled Nursing Facility Services, Day Treatment and Residential treatment will be reimbursed utilizing the per diem methodology. In no event shall a per diem qualify as an Outlier. These benefits shall be allowed when the Member has received Medically Necessary Covered Services subject to the following policy limitations and conditions:
a) EGID shall pay the appropriate percentage of the MS-DRG Allowable Fee and the Member shall pay the remainder of the MS-DRG Allowable Fee unless the Member has met the stop loss limitation, and then EGID shall pay one hundred percent (100%) of the MS-DRG Allowable Fee and the Member has no liability.
b) The MS-DRG shall be controlling, subject to EGID’s approval and Article X of the Contract.
c) The MS-DRG Allowable Fee does not include any physician professional component fees, which are considered for payment according to separately billed Current Procedural Terminology code Allowable Fees.
d) EGID may reduce its payment by any deductibles, coinsurance and co- payments owed by the Member.
e) EGID shall include the day of admission but not the day of discharge when computing the number of facility days provided to a Member. Observation Facility confinements for which a room and board charge is incurred shall be paid based on inpatient benefits.
f) In the case of a transfer, the Transfer Allowable Fee for the transferring Facility shall be calculated as follows: Transfer Allowable Fee = (MS-DRG Allowable Fee/Geometric Mean Length of Stay) x (Length of Stay + 1 day) The total Transfer Allowable Fee paid to the transferring Fa...
Compensation and Billing. 4.1 If you are not an embedded retail generator, you agree that, subject to any applicable law:
a. the LDC will not pay you for any excess generation that results in a net delivery to theLDC between meter reads; and
b. there will be no carryover of excess generation from one billing period to the next unless you are, at the relevant time, a net metered generator (as defined in section 6 .7.1 of the DistributionSystem Code).
4.2 If you are an embedded retail generator selling output from the embedded generation facility to the Ontario Power Authority under contract, you agree that the LDC will pay you for generation in accordance with the Retail Settlement Code.
4.3 If you are an embedded retail generator delivering and selling output to the LDC, you agree that the LDC will pay you for generation in accordance with the Retail Settlement Code.
Compensation and Billing. 1. Group's reimbursement for Covered Services provided to Beneficiaries of Payors participating in this Program shall be the rates set forth and attached hereto in Exhibit A to this Attachment, less applicable Copayments, Deductibles, and Coinsurance, and any applicable administrative fees, which shall not exceed 4%. The rates set forth in Exhibit A to this Attachment shall apply to all Health Care Services rendered to Beneficiaries in the OhioHealthy Program.
2. Group will look solely to Payor for compensation for Covered Services except for Copayments, Deductibles or Coinsurance. Group agrees, that whether or not there is any unresolved dispute for payment, that under no circumstances will Group directly or indirectly make any charges or claims for Covered Services, other than for Copayments, Deductibles or Coinsurance, against any Beneficiaries or their representatives and that this provision survives termination of this Attachment for services rendered prior to such termination. Except for the collection of Copayments, Deductibles or Coinsurance, only those services that are not Covered Services may be billed directly to Beneficiaries, subject to limitations listed above. This paragraph is to be interpreted for the benefit of Beneficiaries and does not diminish the obligation of a Payor to make payments to Group according to the terms of this Agreement.
3. OhioHealthy will remit any amount owing under this OhioHealthy Program Attachment and the Agreement within thirty (30) days after receipt of a complete claim from Group. Payor shall pay claims consistent with Ohio Revised Code sections 3901.381 – 3901.3814. For purposes of this Attachment, a "complete claim" is defined in the Agreement and supplemented by the applicable Payor's Program Manual.
Compensation and Billing. 52.5.2.1. Access by CLEC to the Toll Free Number Database Information - CLEC shall pay a per query charge as detailed in Sprint’s applicable tariff or published price list.
Compensation and Billing. 52.4.3.1. Access by CLEC to CNAM information in Sprint’s CNAM Database - CLEC shall pay a per query charge as detailed in Sprint’s applicable tariff or published price list.
52.4.3.2. Access to Other Companies’ CNAM Database - Access to other companies CNAM shall be provided at a per query rate established for hubbing of $0.0035 and a rate for CNAM queries and switching of $0.016 for a combined rate of $0.0195.
Compensation and Billing. 52.6.2.1. Access by CLEC to the LNP Database information -- CLEC shall pay a per query charge as detailed in Sprint’s applicable tariff or published price list.
52.6.2.2. Billing – Invoices will be sent out by the 15th of each month on a LNP specific invoice.
Compensation and Billing. 6.1 The PHYSICIAN shall seek payment only from EGID for the provision of medical services except as provided in paragraphs 6.3, 6.4 and 6.
Compensation and Billing. County shall compensate Contractor for performing said services in accordance with Exhibit B, attached hereto and incorporated by reference.
Compensation and Billing. 3.1 Throughout the term of this Service Schedule H the following firm rates shall apply:
Compensation and Billing. 6.1 The Dentist shall seek payment only from EGID for the provision of dental services except as provided in paragraphs 6.3 and 6.
