Direct Member Reimbursement Sample Clauses

Direct Member Reimbursement. Pursuant to OAC rule 5160-1-60.2, the MCO must comply with requirements for direct reimbursement for out-of-pocket expenses incurred by members for covered services during approved eligibility periods. If a member properly submits an ODM-approved direct reimbursement packet, the MCO must accept the ODM-approved direct reimbursement packet and complete the direct reimbursement process. If a member makes first contact with the MCO regarding direct reimbursement, the MCO must complete the direct reimbursement process but may use the MCO's own direct reimbursement process and documents.
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Direct Member Reimbursement. 1. Pursuant to OAC rule 5160-1-60.2, the MCO must comply with requirements for direct reimbursement for out-of-pocket expenses incurred by members for covered services during approved eligibility periods.
Direct Member Reimbursement. Upon request, Navitus will provide an Eligible Person with a Navitus-approved claim form that must be used when submitting a Claim for reimbursement for Covered Products provided by a Participating or Non-Participating Pharmacy. When such a Claim is submitted on the approved form, Navitus will process the Claim according to the Plan Guidelines and in the amount approved by the Client for payment. The Claim forms should be sent to: Navitus Health Solutions LLC, X.X. Xxx 000, Xxxxxxxx, Xxxxxxxxx 00000-0000, or such other address designated by Navitus upon written notice.
Direct Member Reimbursement. Either PBM or Sponsor shall provide a Member with an approved Claim form for use for reimbursement for Prescription Drug Services provided by a Participating or non-Participating Pharmacy for direct Member reimbursement (“DMR”). DMR claims will be submit by members and PBM shall process any DMR Claims submitted by members. When a DMR Claim is submitted by a Member or a third party, the PBM shall process the DMR Claim according to the Benefit Plan and pay an amount that would have been approved by Sponsor for payment. PBM shall charge Sponsor $0.00 per DMR.
Direct Member Reimbursement. At least ninety-nine percent (99%) Five thousand of clean claims adjudicated within 30 days. ($5,000) dollars for each percentage point for which the standard is not met in each month

Related to Direct Member Reimbursement

  • Expense Reimbursement The Executive shall be entitled to receive reimbursement for all appropriate business expenses incurred by him in connection with his duties under this Agreement in accordance with the policies of the Company as in effect from time to time.

  • Course Reimbursement 15.9.1 Prior approval by the Department of Accountability & Staff and School Renewal is required.

  • Professional Development Reimbursement Management will provide reimbursement for approved professional development expenses for Lieutenants and Sergeants. Funds may be used for the purpose of improving job performance, maintaining and increasing proficiency, preparing Lieutenants and Sergeants for greater responsibility, or increasing promotional opportunities. Management must approve of the specific professional development request in advance. Denial will require written notification to the requesting Lieutenant or Sergeant.

  • REPORT ON CONTRACT SALES ACTIVITY AND ADMINISTRATIVE FEE PAYMENT A. CONTRACT SALES ACTIVITY REPORT. Each calendar quarter, Supplier must provide a contract sales activity report (Report) to the Sourcewell Supplier Development Administrator assigned to this Contract. Reports are due no later than 45 days after the end of each calendar quarter. A Report must be provided regardless of the number or amount of sales during that quarter (i.e., if there are no sales, Supplier must submit a report indicating no sales were made). The Report must contain the following fields: • Participating Entity Name (e.g., City of Staples Highway Department); • Participating Entity Physical Street Address; • Participating Entity City; • Participating Entity State/Province; • Participating Entity Zip/Postal Code; • Participating Entity Contact Name; • Participating Entity Contact Email Address; • Participating Entity Contact Telephone Number; • Sourcewell Assigned Entity/Participating Entity Number; • Item Purchased Description; • Item Purchased Price; • Sourcewell Administrative Fee Applied; and • Date Purchase was invoiced/sale was recognized as revenue by Supplier.

  • Education Reimbursement The County will provide education reimbursement for education costs incurred by regular employees who apply for such reimbursement in accordance with the policies and procedures governing the education reimbursement program. The maximum reimbursement shall be $1,500 per year.

  • Educational Reimbursement SECTION 1. The purpose of this Article is to xxxxxx a learning environment and provide educational opportunities that are mutually beneficial to the employees and the County and will encourage eligible employees to participate in education programs which will further their skills and knowledge for use in their current position or for use in a possible future position of greater responsibility. The Educational Reimbursement Program shall be a plan as provided for in Section 127 of the Internal Revenue Code of 1986, as amended (the “Code”) and shall be construed consistently with the requirements of Section 127. Amounts paid for tuition reimbursement meeting the requirements of Section 127 of the IRS Tax Code are not included in an Employee’s income or subject to income tax withholding up to a maximum of $5,250 annually. If subsequent tax law changes fail to continue the tax-free treatment, or in any way modify its treatment, appropriate adjustments in tax withholding will be made from the effective date of the change. This Article does not apply to training seminars, conferences, workshops, etc.

  • Uncovered Health Care Expenses ☐ Husband ☐ Wife shall be responsible for medical, dental, orthodontic, optical, psychiatric, psychological, and other health care expenses of the Minor Children, to the extent not covered by insurance. The Spouse incurring the expense shall present to the other Spouse an itemized statement of costs accrued or paid, proof of payment of any costs paid by the Spouse, and any necessary information about how to make payment to the provider within a reasonable time, but not more than days after accruing the costs. The reimbursing Spouse shall make the required payment or reimbursement within a reasonable time, but not more than days after notification of the amount due. For purposes of duration and modification, this provision shall be deemed part of the Child Support orders made by the court in the Couples’ dissolution action. ☐ - Other. ☐ Husband the ☐ Wife agrees to make payment to the other Spouse for the following:

  • Nomination Fees The Allottee shall pay a sum calculated @ 2% of the Unit Price or the Nomination Price whichever is higher, plus applicable taxes, as and by way of nomination fees to the Promoter. It is clarified that inclusion of a new joint allottee or change of a joint allottee shall be treated as a nomination. However nomination fees shall not be payable in case of nomination in favour of parents, spouse or children of the Allottee. Any additional income tax liability that may become payable by the Promoter due to nomination by the Allottee because of higher market valuation as per the registration authorities on the date of nomination and/or the extra registration fees to be paid to the registration authorities due to nomination, shall be compensated by the Allottee paying to the Promoter agreed compensation equivalent to the income tax payable on such difference at the highest applicable tax rate at the prevailing time or the estimated extra registration fees. Such amount shall be payable by the Allottee on or before nomination. The Allottee admits and accepts that he shall not be entitled to nominate or assign his rights under this Agreement save in the manner indicated above.

  • Travel Reimbursement 2.1 The County will only cover costs associated with travel on vendors outside a 50 mile radius from Xxxxxxxxxx County, Texas.

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