Denial of Payment. The State will deny payments for new Enrolled Members when, and for so long as, payment for those Enrolled Members is denied by CMS based on the
Denial of Payment. Notwithstanding the foregoing provisions of this section, such payment shall not be made pursuant to this subsection to a Member:
(1) who does not apply for or receive temporary disability benefits under the Worker's Compensation Law;
(2) whose injury or illness has become permanent;
(3) whose injury or illness, although continuing to show improvement, is unlikely to improve sufficiently to permit the Member's return to work in his position;
(4) who is retired on permanent disability or pension;
(5) whose injury or illness is the result of intentional failure to observe City health or safety regulations or the commission of a criminal offense;
(6) whose injury or illness has been aggravated or delayed in healing by reason of the Member's failure to receive medical treatment or follow medical advice, except where such treatment or advice has not been sought or followed by reason of the Member's religious beliefs; and
(7) whose injury or illness is a recurrence or re-injury of an earlier job- related injury or illness or is contributed to by a susceptibility or predisposition to such injury.
Denial of Payment. The State will deny payments for new Enrolled Members when, and for so long as, payment for those Enrolled Members is denied by CMS. CMS may deny payment to the State for new Enrolled Members if its determination is not timely contested by the Contractor. See: 42 C.F.R. § 438.726(b); 42 C.F.R. § 438.730(e)(1)(ii); 42 C.F.R. § 457.1270. {From CMSC J.5.17}. Limitation on Imposition of Temporary Management. Under this Contract, temporary management may only be imposed when the State finds, through onsite surveys, Enrolled Member or other complaints, financial status, or any other source:
Denial of Payment. County will deny payment for:
(d) All non-emergency services for which the required treatment authorization request form was not obtained prior to rendering such services; and
(e) Services claimed as emergency services, which are determined not to have been emergency services.
(f) Such denial shall not create any liability on the part of the Client, and Contractor shall neither bill nor collect from the Client any charges in connection with such services.
Denial of Payment. For denial of payment, the IHCP must mail or hand -deliver notice of action on the date of the denial.
Denial of Payment. The Contractor must give notice on the date of action when the action is a denial of payment.
Denial of Payment. If Medicare or its agent notifies Health Care Facility that due to inaccurate or incomplete information that is necessary to complete the MDS Assessment and is required to be provided by Kindred with respect to any Service Medicare: (i) reclassifies a resident to a lower RUGS category, or (ii) issues a denial or disallowance on the grounds that such Services were not medically necessary, Health Care Facility will be entitled to offset against Kindred's next invoice to Health Care Facility an amount equal to the amount previously paid to, or billed by, Kindred for such unreimbursed Service for that specific resident.
Denial of Payment. If a position with GCOM or its Client is obtained by Contractor or its Designated Personnel through an impersonator, misrepresentation of the Designated Personnel’s education, experience or other qualifications, or any other fraudulent conduct, GCOM shall have the right to terminate the Designated Personnel and/or Contractor and to deny payment for any services Designated personnel purportedly provided.
