Compensation to Participating Providers Sample Clauses

Compensation to Participating Providers. The TPA agrees to provide and manage a comprehensive provider network in the State of Mississippi that will serve the Plan exclusively, and agrees that the Board will have approval authority for any or all contracted rates and terms of the provider contracts for purposes of assuring that the contracted providers agree to participate in or cooperate with the Plan’s medical management and utilization review programs, health and wellness promotion programs, and all other features and programs of the Plan as appropriate. The TPA’s contracts with participating providers shall include provisions pertaining to the compensation of those providers, as described in the sections below. 1. Each network provider contracted by the TPA shall be entitled to compensation for covered services rendered in an amount not to exceed the TPA’s allowable charge. For DRG or per diem rates, the allowable charge is the lessor of the billed charge, the DRG or per diem rate. Network providers shall neither xxxx nor attempt to collect from the participant, the Plan, the Board, or any third party, any amount in excess of the TPA’s allowable charge for any covered service. 2. The participating hospitals contracted by the TPA shall accept and adhere to the allowable charge for covered hospital services when the Plan is the primary payor. When the Plan is the secondary payor under coordination of benefits rules, the allowable charge shall not apply. 3. Network providers shall be entitled to collect from the participant any deductible, co payment, or co insurance amounts specified by the Plan. 4. Network providers shall be entitled to compensation from the participant for health care services not covered under the Plan, for health care services provided to a participant after the benefits set forth in the Plan have been exhausted, or for health care services which are otherwise excluded under the Plan (including any services for which payment is denied under the Plan’s utilization management program provided that the network provider fully cooperated with the utilization management program up to and including the appeals process). Network providers shall not be entitled to compensation from the participant nor from the Plan for services that are not medically necessary, as determined by the medical management and utilization review vendor or by the claims administrator.
Sample 1Sample 2
AutoNDA by SimpleDocs
Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement.
Sample 1Sample 2
Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. Vendor shall provide the services described in this Addendum. To the extent required by a regulatory or accreditating agency, (a) the parties shall document to the level of specificity required by applicable government authorities and/or United’s accreditation agencies the activities relating to the services that have been delegated under this Exhibit to Vendor in accordance with the timeframes required; (b) before activities are delegated under this Agreement, United will or has conducted a pre‑assessment audit of Vendor to assess Vendor’s ability to fulfill the terms of this Agreement for any delegated activities; and (c) upon request by United, Vendor shall cooperate and participate, either telephonically or personally, in accreditation and/or state or federal regulatory audits, including interview sessions, related to the delegated activities provided under this Agreement. This section (c) shall survive termination of this Agreement, Exhibit and the delegated activities.
Sample 1
Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. Attachment 2.10.3 Appendix F - Dental Benefit Providers - Executed Contract This Fifth Amendment to the Dental Services Agreement (this “Amendment”), is entered into as of August 1, 2018 (the “Amendment Effective Date”) by and between Dental Benefit Providers, Inc. (“Vendor”) and UnitedHealthcare of Louisiana, Inc. (“United”).
Sample 1
Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. “Appendix”) supplements and is made part of the agreement (the “Agreement”) with Dental Benefits Providers, Inc. (“Subcontractor”).
Sample 1
Compensation to Participating Providers. (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. VISION SERVICES AGREEMENT‌‌‌ This Vision Services Agreement (this “Agreement”), is entered into as of July 1, 2019 (the “Effective Date”), by and between March Vision Care Group Incorporated (“Vendor”) and UnitedHealthcare of Kentucky, Inc. (“United”). For services provided on or after its Effective Date, this Agreement supersedes and replaces any and all other agreements, whether written or oral, between the parties regarding the subject matter contained herein.
Sample 1
Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. OHCS PHS - UHCKY AM04 IIPAS Contract ID: 6233-E Optum Contract ID: 00172839.2 Kentucky HEALTH refers to the Section 1115 Demonstration Waiver known as Kentucky Helping to Engage and Achieve Long Term Health (HEALTH). (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. OHCS PHS - UHCKY AM04 IIPAS Contract ID: 6233-E Optum Contract ID: 00172839.2 Kentucky HEALTH refers to the Section 1115 Demonstration Waiver known as Kentucky Helping to Engage and Achieve Long Term Health (HEALTH). ADMINISTRATIVE SERVICES AGREEMENT‌ This Administrative Services Agreement (this “Agreement”), is made as of March 1, 2013 (the “Effective Date”), by and between OptumHealth Care Solutions, Inc. (“Vendor”) and UnitedHealthcare of Kentucky, Ltd. (“United”). For services provided on or after its Effective Date, this Agreement supersedes and replaces any and all other agreements, whether written or oral, between the parties regarding the subject matter contained herein.
Sample 1
AutoNDA by SimpleDocs
Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. UBH- UHCKY AM08 IIPAS Contract ID:6087-H Optum Contract ID: 00172840.3 4 BEHAVIORAL HEALTH SERVICES AGREEMENT‌ This Administrative Services Agreement (this “Agreement”), is made as of March 01, 2012 (the “Effective Date”), by and between United Behavioral Health and its subsidiaries (“Vendor”) and UnitedHealthcare of Kentucky, Ltd. (“United”). For services provided on or after its Effective Date, this Agreement supersedes and replaces any and all other agreements, whether written or oral, between the parties regarding the subject matter contained herein.
Sample 1
Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. NEMT Services Vendor shall provide the services described in this Addendum. To the extent required by a regulatory or accrediting agency,‌‌ (a) the parties shall document to the level of specificity required by applicable government authorities and/or United’s accreditation agencies the activities relating to the services that have been delegated under this Exhibit to Vendor in accordance with the timeframes required; (b) before activities are delegated under this Agreement, United will or has conducted a pre-assessment audit of Vendor to assess Vendor’s ability to fulfill the terms of this Agreement for any delegated activities; and (c) upon request by United, Vendor shall cooperate and participate, either telephonically or personally, in accreditation and/or state or federal regulatory audits, including interview sessions, related to the delegated activities provided under this Agreement. This section (c) shall survive termination of this Agreement, Exhibit and the delegated activities.
Sample 1

Related to Compensation to Participating Providers

  • Services and Compensation Consultant shall perform the services described in Exhibit A (the “Services”) for the Company (or its designee), and the Company agrees to pay Consultant the compensation described in Exhibit A for Consultant’s performance of the Services.

  • Compensation to NCPS (a) Issuer Party shall pay or cause to be paid to NCPS for its services as the facilitator of escrow as outlined in Exhibit B, which may be updated from time to time by NCPS by providing written notice to Issuer Party. Issuer Party’s obligation to pay such fees to NCPS and reimburse NCPS for such expenses is not conditioned upon a successful closing. Upon Issuer Party’s request, NCPS will provide Issuer Party with copies of all relevant invoices, receipts or other evidence of such expenses. The obligations of Issuer Party under this Section 10 shall survive any termination of this Agreement and the resignation or removal of NCPS. (b) All of the compensation and reimbursement obligations shall be payable by Issuer Party upon demand by NCPS and will be charged automatically by NCPS to the credit card or other payment method separately provided or as otherwise agreed by the Parties. Issuer Party consents to NCPS retaining and using Issuer Party’s payment information for future invoices and as provided in this Agreement. Issuer Party agrees and acknowledges that NCPS and its third party vendors may retain and use Issuer Party’s payment information to facilitate the payments provided for in this Agreement. Issuer Party agrees to provide NCPS written notice (which may be via email) of any update or changes to Issuer Party’s payment information. Absent current payment information, Issuer Party shall make, or cause to be made, all payments to NCPS within 10 days of receiving an invoice therefor. All payments made to NCPS shall be in US dollars in immediately available funds. (c) If Issuer Party fails to make any payment when due then, in addition to all other remedies that may be available: (a) NCPS may charge interest on the past due amount at the rate of 1.5% per month, calculated daily and compounded monthly, or if lower, the highest rate permitted under Law, which Issuer Party shall pay; such interest may accrue after as well as before any judgment relating to collection of the amount due; and (b) Issuer Party shall reimburse, or cause to be reimbursed, NCPS for all costs incurred by NCPS in collecting any late payments or interest, including attorneys’ fees, court costs and collection agency fees; provided that cumulative late payments are subject to the overall limits as may be required by Law as set forth in Exhibit B. (d) Only upon the fulfillment of the Minimum Offering, and only when Escrowed Funds are eligible to be released to Issuer in accordance with Section 4(a), and otherwise in compliance with Law, NCPS is authorized to and may disburse from time to time, to itself or to any NCPS Party from the Escrow Funds (but only to the extent of Issuer’s rights thereto), the amount of any compensation and reimbursement of out-of-pocket expenses due and payable hereunder (including any amount to which NCPS or any NCPS Party is entitled to seek indemnification pursuant to Section 9 hereof). NCPS shall notify Issuer Party of any disbursement from the Escrow Funds to itself or to any NCPS Party in respect of any compensation or reimbursement hereunder and shall furnish to Issuer copies of all related invoices and other statements. (e) Only upon the fulfillment of the Minimum Offering, and only when Escrowed Funds are eligible to be released to Issuer in accordance with Section 4(a), and otherwise in compliance with Law, Issuer shall grant to NCPS and the NCPS Parties a security interest in and lien upon such Escrow Funds (but only to the extent of Issuer’s rights thereto) to secure all obligations hereunder, and NCPS and the NCPS Parties shall have the right to offset the amount of any compensation or reimbursement due any of them hereunder (including any claim for indemnification pursuant to Section 9 hereof) against the Escrow Funds (but only to the extent of Issuer’s rights thereto). If for any reason the Escrow Funds available to NCPS and the NCPS Parties pursuant to such security interest or right of offset are insufficient to cover such compensation and reimbursement, Issuer Party shall promptly pay such amounts to NCPS and the NCPS Parties upon receipt of an itemized invoice.

  • Fees and Compensation Managers and Officers may receive such compensation and fees, if any, for their services, and such reimbursement for expenses, as may be determined by resolution of the Board.

  • COMPENSATION TO CONSULTANT The Consultant's compensation for the Consulting Services shall be as set forth in Exhibit B attached hereto and incorporated herein by this reference.

  • Compensation for Basic Services A. Owner shall make payment for Part I and Part II services monthly. The payments shall be in proportion to the progress of Engineer's work. Final payment for each phase shall become due and payable upon completion and approval by Owner of that phase of Engineer's work. B. Owner shall make payment for Construction Phase services not more frequently than monthly in proportion to the amount of the gross progress payments to Contractor(s). C. Owner shall make no deduction from Engineer's compensation on account of penalties, liquidated damages or other sums withheld from Contractor(s) through no fault of Engineer. D. Owner shall make payment for Construction Completion Phase services upon completion of the requirements set forth in subsections II. F. 1, 2 and 3. E. Engineer shall submit requests for payment monthly on forms provided and in a manner prescribed by Owner.

  • Employees and Compensation (A) Shown on Schedule 6.15(A) is a list of the name of each employee, sales agent or other Person, separately identified as to part-time or full-time, who is currently employed in the Business by Seller, together with each Person’s job classification, date of hire, and current rate of compensation (or method for computing same). All employees of Seller are “at will” employees whose employment may be terminated by Seller at any time, with or without notice or cause. (B) Schedule 6.15(B) hereto lists all compensation and benefit plans, contracts and arrangements maintained, sponsored or participated in by Seller or any of its Affiliates in connection with the Business and in effect as of the date hereof including, without limitation, all pension (including all such employee pension benefit plans as defined in Section 3(2) of ERISA), profit-sharing, savings and thrift, fringe benefit, bonus, incentive or deferred compensation, severance pay and medical and life insurance plans and employee welfare plans as defined in Section 3(1) of ERISA that are sponsored by Seller or any of its Affiliates and in which any employees of Seller participate (collectively, “Employee Benefit Plans”). (C) As to Employee Benefit Plans sponsored by Seller or its Affiliates that are “employee pension benefit plans” as defined in Section 3(2) of ERISA, such plans sponsored by Seller or its Affiliates are tax qualified under Section 401(a) of the Code, are not currently under examination by, nor are any matters pending before, the Internal Revenue Service, the Employee Benefits Security Administration or any quasi-government agency, are not subject to any claim, suit or arbitration (other than routine claims for benefits), are not subject to the minimum funding standards of Code Section 412, are in compliance with and have been administered in accordance with their terms and in compliance with all applicable requirements of law, including, but not limited to, the Code and ERISA, and there have been no prohibited transactions as defined in Code Section 4975 or ERISA Section 406 with respect to such plans that could subject Seller or its Affiliates to a tax or penalty under Code Section 4975 or ERISA Section 502(i). (D) Neither Seller nor any of its Affiliates has incurred any Liability under Title IV of ERISA that has or could, after the Effective Date, become a Lien upon any of the Purchased Assets pursuant to ERISA Section 4068. (E) Neither Seller nor any of its Affiliates is or has ever been required to contribute to any “multiemployer plan,” as such term is defined in Section 4001(a)(3) of ERISA, in which any employees of Seller in connection with the Business participate. (F) Except as set forth in Schedule 6.15(F), no Employee Benefit Plan provides medical, surgical, hospitalization, death or similar benefits (whether or not insured) for employees for period extending beyond their retirement or other termination of service, other than (i) coverage mandated by applicable law, or (ii) death benefits under any pension plan. (G) For the purposes of this Section 6.15, Seller shall include all trades or business under common control with Seller as provided in the regulations under Code Section 414(c).

  • Compensation for Consulting Services For each quarter (i.e., three-month period) that Executive provides consulting services to MediciNova pursuant to the option of MediciNova contained in Section 9 above, MediciNova shall pay Executive a sum equal to fifteen percent (15%) of Executive’s annual Base Compensation which shall be applicable at the time of Executive’s termination of employment with MediciNova (prorated for any period of less than a quarter). The parties expressly agree that when Executive is performing consulting services for MediciNova, Executive is acting as an independent contractor. Therefore, Executive shall be solely liable for Social Security and income taxes that result from Executive’s compensation as a consultant. In addition, Executive shall not be entitled to any other benefits including, without limitation, such group medical, life and disability insurance and other benefits as may be provided to employees and/or executives of MediciNova.

  • COMPENSATION TO THE ADVISOR The Trust shall pay the Advisor, out of the assets of a Fund, as full compensation for all services rendered, an advisory fee for such Fund set forth below. Such fee shall be calculated by applying the following annual rates to the average daily net assets of such Fund for the calendar year computed in the manner used for the determination of the net asset value of shares of such Fund.

  • PROFESSIONAL COMPENSATION 11.1 The basic salaries of teachers covered by this Contract shall be set in accordance with the procedures set forth in this Agreement. 11.2 The salary of the teacher will be presumed correct as shown in the Uniform Teacher’s Contract unless the teacher or the Employer furnishes evidence of error. 11.3 An explanation as to how contract salary figures are computed will accompany the first paycheck of each school year. 11.4 Basic salaries for teachers shall be paid in twenty-six (26) payments. Basic salaries for teachers shall be paid in twenty-six (26) payments in a given calendar year. Exceptions may be made with the approval of the Cash Flow Committee. A teacher may receive the balance due on his contract with the first scheduled paycheck in July by written notice to the Business Office by May 1. If May 1 occurs on a day that school is not in session, the deadline shall be the next regular school day. A teacher who makes this election shall continue each year to receive the balance due on his contract with the first scheduled paycheck in July unless he notifies the Business Office by May 1 that he prefers to be paid in twenty-six (26) payments. Teachers will be notified by the Cash Flow Committee of the Xxxxxxx Teachers’ Federation prior to June 1 in the event the balance on teachers’ contracts due on the first scheduled paycheck in July cannot be paid. 11.5 New teachers will receive one half (½) of their first pay one payroll in advance and the remaining one half (½) on the next pay date. 11.6 Effective January 1, 2009, teacher pay will be issued via direct deposit only. 11.7 The Superintendent may approve additional compensation for individual teachers who have been authorized by the Superintendent to perform additional work assignments. 11.8 Payroll deductions for teachers shall be made as required by law or as mutually agreed to by the parties. Teachers may authorize deductions for tax-sheltered annuities during open enrollment periods of the carrier companies involved. 11.9 Deductions for daily absences not covered by provisions in the Contract shall be made at the same rate as earned. 11.10 Effective January 1, 1993, the Board shall pay directly to the Indiana State Teachers Retirement Fund each teacher’s three percent (3%) contribution to the fund. 11.11 The parties recognize that the salaries which appear on Regular Teacher’s Contracts and Teacher’s Temporary Contracts will be inaccurate whenever a salary increase is approved after these contracts have been executed. At the time of a teacher’s retirement, the Employer will review these contracts and, when necessary, revise the contracts for the five (5) years of service before retirement in which the teacher’s annual compensation was highest so they accurately reflect the sums which the teacher earned in each of those five (5) years. 11.12 The parties recognize that students are entitled to be taught by fully qualified teachers, while at the same time recognizing a professional responsibility to assist in the preparation of student teachers. Therefore, supervision by a teacher of a student teacher shall be voluntary. No teacher should serve as a supervising teacher more than one-half (1/2) of the total teaching time each year. This provision was not bargained and has been included for informational purposes only. Should 11.13 If the Employer determines that any committee should continue its work during the summer, teachers belonging to the committee performing such services shall be paid on the same basis and in the same manner as summer school teachers. If the Employer determines that professional development should occur in the summer, specific teachers invited to participate shall be paid on the same basis as summer school teachers.

  • Director Compensation Petitioner shall not compensate members of the Charter School’s Governing Board in excess of reasonable expenses incurred in connection with actual attendance at board meetings or with performance of duties associated therewith.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!