Eligibility and Benefit Verification Sample Clauses

Eligibility and Benefit Verification. BCBSM will provide Facility with a system and/or method to promptly verify eligibility and benefit coverages of Members; provided that any verification will be given as a service and not as a guarantee of payment.
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Eligibility and Benefit Verification. BCBS will provide Facility with a system and/or method to verify eligibility and benefit coverages of Members; provided that any such verification will be given as a service and not as a guarantee of payment.
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Eligibility and Benefit Verification. BCBSM will provide CRNA with a system and/or method to promptly verify eligibility and benefit coverages of Members; provided that any such verification by BCBSM will be given as a service and not as a guarantee of payment.
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Eligibility and Benefit Verification. HealthAmerica or other Member Company shall be responsible for the determination under each Program as to whether (i) a person receiving services, supplies, products or accommodations from an AHERF Provider is a Covered Individual, and (ii) the services, supplies, products and accommodation provided to a Covered Individual are Covered Services. The Member Company shall use its reasonable efforts to provide AHERF and AHERF Providers with real time access to the Member Company's eligibility files to verify a Covered Individual's eligibility and coverage. HealthAmerica agrees that such verification process shall be reasonable and consistently and uniformly applied to each HealthAmerica Participating Provider. HealthAmerica shall make eligibility determinations according to its then current policies. As to AHERF Providers being compensated on a capitation basis, if a Covered Individual's eligibility has been canceled retroactively, HealthAmerica may deduct from payments to be made to the AHERF Provider an amount equal to the capitation payments paid to the AHERF Provider on account of such Covered Individual after the date of the retroactive cancellation: provided, however, such amount shall not exceed an amount equal to three (3) months of capitation payments for such Covered Services. The AHERF Provider may bill xxxh Covered Individual for services rendered during such period of ineligibility, which billing shall not constitute a violation of Sections 5.9. If a Covered Individual's enrollment in an AHERF Provider's practice has been added retroactively for three (3) or more months, HealthAmerica shall make a capitation payment equal to three months of capitation payments for such Covered Individual. The foregoing financial terms and conditions shall be AHERF Provider's sole and exclusive remedy for failing to notify HealthAmerica or Member Company of a Covered Individual's enrollment in an AHERF Provider's practice. AHERF Providers shall provide health care services to Covered Individuals without prior verification of eligibility or authorization in cases of an emergency.
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Eligibility and Benefit Verification. Plan shall be responsible for the determination whether (i) a person receiving services, supplies, products or accommodations from a BJC Provider is a BJC Medicaid Member, and (ii) the services, supplies, products and accommodation provided to a BJC Medicaid Member are Covered Services. Plan shall provide BJC with the claims and eligibility reports attached hereto as EXHIBIT E and Plan shall use its reasonable efforts to provide BJC and BJC Providers in the future with real time access to Plan's eligibility files to verify BJC Medicaid Member eligibility and coverage. Plan agrees that its eligibility verification processes shall be reasonable and consistently and uniformly applied to each BJC Provider. Plan shall make eligibility determinations according to its then current policies.
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Eligibility and Benefit Verification. Provider will be responsible for verifying Member eligibility and coverage through such processes as BCBSM shall establish from time to time.
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Eligibility and Benefit Verification. Plan shall be responsible for the determination under each Benefit Plan covered under the scope of this Exhibit as to whether (i) a person receiving services, supplies, products or accommodations from a BJC Provider is a BJC Medicare Member, and (ii) the services, supplies, products and accommodation provided to a BJC Medicare Member are Covered Services. Plan shall provide BJC the claims and eligibility reports set forth in EXHIBIT E and shall use its reasonable efforts to provide BJC and BJC Providers in the future with real time access to Plan's eligibility files to verify BJC Medicare Member eligibility and coverage. Plan agrees that its eligibility verification processes shall be reasonable and consistently and uniformly applied to each BJC Provider. Plan shall make eligibility determinations according to its then current policies.
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Eligibility and Benefit Verification. Plan shall be responsible for the determination under each Benefit Plan covered under the scope of this Exhibit as to whether (i) a person receiving services, supplies, products or accommodations from a BJC Provider is a Member, and
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Related to Eligibility and Benefit Verification

  • Employee Eligibility Verification The Contractor warrants that it fully complies with all Federal and State statutes and regulations regarding the employment of aliens and others and that all its employees performing work under this Contract meet the citizenship or alien status requirement set forth in Federal statutes and regulations. The Contractor shall obtain, from all employees performing work hereunder, all verification and other documentation of employment eligibility status required by Federal or State statutes and regulations including, but not limited to, the Immigration Reform and Control Act of 1986, 8 U.S.C. §1324 et seq., as they currently exist and as they may be hereafter amended. The Contractor shall retain all such documentation for all covered employees for the period prescribed by the law. The Contractor shall indemnify, defend with counsel approved in writing by County, and hold harmless, the County, its agents, officers, and employees from employer sanctions and any other liability which may be assessed against the Contractor or the County or both in connection with any alleged violation of any Federal or State statutes or regulations pertaining to the eligibility for employment of any persons performing work under this Contract.

  • Employment Eligibility Verification As required by IC § 22-5-1.7, the Contractor swears or affirms under the penalties of perjury that the Contractor does not knowingly employ an unauthorized alien. The Contractor further agrees that: A. The Contractor shall enroll in and verify the work eligibility status of all his/her/its newly hired employees through the E-Verify program as defined in IC § 22-5-1.7-3. The Contractor is not required to participate should the E-Verify program cease to exist. Additionally, the Contractor is not required to participate if the Contractor is self-employed and does not employ any employees. B. The Contractor shall not knowingly employ or contract with an unauthorized alien. The Contractor shall not retain an employee or contract with a person that the Contractor subsequently learns is an unauthorized alien. C. The Contractor shall require his/her/its subcontractors, who perform work under this Contract, to certify to the Contractor that the subcontractor does not knowingly employ or contract with an unauthorized alien and that the subcontractor has enrolled and is participating in the E-Verify program. The Contractor agrees to maintain this certification throughout the duration of the term of a contract with a subcontractor. The State may terminate for default if the Contractor fails to cure a breach of this provision no later than thirty (30) days after being notified by the State.

  • Eligibility Verification (a) HHSC will verify Medicaid eligibility for Dual Eligible Members by the fifth business day of the month following the receipt of the MA Dual SNP’s monthly enrollment file, in accordance with Section 3.02(b). (b) To verify Medicaid eligibility of an individual Member, HHSC agrees to provide the MA Dual SNP with real-time access to HHSC’s claims administrator’s Medicaid eligibility verification system.

  • Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.

  • Verification of Employment Eligibility By executing this Agreement, Consultant verifies that it fully complies with all requirements and restrictions of state and federal law respecting the employment of undocumented aliens, including, but not limited to, the Immigration Reform and Control Act of 1986, as may be amended from time to time, and shall require all subconsultants and sub-subconsultants to comply with the same.

  • Overtime Eligibility An Employee must work at least fifteen (15) minutes beyond her normal shift before being eligible for overtime compensation.

  • Eligibility and Enrollment 2.3.1 The State of Georgia has the sole authority for determining eligibility for the Medicaid program and whether Medicaid beneficiaries are eligible for Enrollment in GF. DCH or its Agent will determine eligibility for PeachCare for Kids™ and will collect applicable premiums. DCH or its agent will continue responsibility for the electronic eligibility verification system (EVS). 2.3.2 DCH or its Agent will review the Medicaid Management Information System (MMIS) file daily and send written notification and information within two (2) Business Days to all Members who are determined eligible for GF. A Member shall have thirty (30) Calendar Days to select a CMO plan and a PCP. Each Family Head of Household shall have thirty (30) Calendar Days to select one (1) CMO plan for the entire Family and PCP for each member. DCH or its Agent will issue a monthly notice of all Enrollments to the CMO plan. 2.3.3 If the Member does not choose a CMO plan within thirty (30) Calendar Days of being deemed eligible for GF, DCH or its Agent will Auto-Assign the individual to a CMO plan using the following algorithm: · If an immediate family member(s) of the Member is already enrolled in one CMO plan, the Member will be Auto-Assigned to that plan; · If there are no immediate family members already enrolled and the Member has a Historical Provider Relationship with a Provider, the Member will be Auto-Assigned to the CMO plan where the Provider is contracted; · If the Member does not have a Historical Provider Relationship with a Provider in any CMO plan, or the Provider contracts with all plans, the Member will be Auto-Assigned based on an algorithm determined by DCH that may include quality, cost, or other measures. 2.3.4 Enrollment, whether chosen or Auto-Assigned, will be effective at 12:01 a.m. on the first (1st) Calendar Day of the month following the Member selection or Auto-Assignment, for those Members assigned on or between the first (1st) and twenty-fourth (24th) Calendar Day of the month. For those Members assigned on or between the twenty-fifth (25th) and thirty-first (31st) Calendar Day of the month, Enrollment will be effective at 12:01 a.m. on the first (1st) Calendar Day of the second (2nd) month after assignment. 2.3.5 In the future, at a date to be determined by DCH, DCH or its Agent may include quality measures in the Auto-Assignment algorithm. Members will be Auto-Assigned to those plans that have higher scores based on quality, cost, or other measures to be defined by DCH. This factor will be applied after determining that there are no Historical Provider Relationships. 2.3.6 In any Service Region, DCH may, at its discretion, set a threshold percentage for the enrollment of members in a single plan and change this threshold percentage at its discretion. Members will not be Auto-Assigned to a CMO plan that exceeds this threshold unless a family member is enrolled in the CMO plan or a Historical Provider Relationship exists with a Provider that does not participate in any other CMO plan in the Service Region. When DCH changes the threshold percentage in any Service Region, DCH will provide the CMOs in the Service Region with a minimum of fourteen (14) days advance notice in writing. 2.3.7 DCH or its Agent will have five (5) Business Days to notify Members and the CMO plan of the Auto-Assignment. Notice to the Member will be made in writing and sent via surface mail. Notice to the CMO plan will be made via file transfer. 2.3.8 DCH or its Agent will be responsible for the consecutive Enrollment period and re-Enrollment functions. 2.3.9 Conditioned on continued eligibility, all Members will be enrolled in a CMO plan for a period of twelve (12) consecutive months. This consecutive Enrollment period will commence on the first (1st) day of Enrollment or upon the date the notice is sent, whichever is later. If a Member disenrolls from one CMO plan and enrolls in a different CMO plan, consecutive Enrollment period will begin on the effective date of Enrollment in the second (2nd) CMO plan. 2.3.10 DCH or its Agent will automatically enroll a Member into the CMO plan in which he or she was most recently enrolled if the Member has a temporary loss of eligibility, defined as less than sixty (60) Calendar Days. In this circumstance, the consecutive Enrollment period will continue as though there has been no break in eligibility, keeping the original twelve (12) month period. 2.3.11 DCH or its Agent will notify Members at least once every twelve (12) months, and at least sixty (60) Calendar Days prior to the date upon which the consecutive Enrollment period ends (the annual Enrollment opportunity), that they have the opportunity to switch CMO plans. Members who do not make a choice will be deemed to have chosen to remain with their current CMO plan. 2.3.12 In the event a temporary loss of eligibility has caused the Member to miss the annual Enrollment opportunity, DCH or its Agent will enroll the Member in the CMO plan in which he or she was enrolled prior to the loss of eligibility. The member will receive a new 60-calendar day notification period beginning the first day of the next month. 2.3.13 In accordance with current operations, the State will issue a Medicaid number to a newborn upon notification from the hospital, or other authorized Medicaid provider. 2.3.14 Upon notification from a CMO plan that a Member is an expectant mother, DCH or its Agent shall mail a newborn enrollment packet to the expectant mother. This packet shall include information that the newborn will be Auto-Assigned to the mother’s CMO plan and that she may, if she wants, select a PCP for her newborn prior to the birth by contacting her CMO plan. The mother shall have ninety (90) Calendar Days from the day a Medicaid number was assigned to her newborn to choose a different CMO plan. 2.3.15 DCH may, at its sole discretion, elect to modify this threshold and/or use quality based auto-assignments for reasons it deems necessary and proper.

  • Student Eligibility The LEA and POSTSECONDARY INSTITUTION shall qualify and advise candidates for dual credit from the pool of eligible high school students. A candidate for dual credit is eligible for consideration for fall, spring, and summer semesters if he or she: a. is enrolled during the fall and spring in a LEA in one-half or more of the minimum course requirements approved by PED for public school students under its jurisdiction or by being in physical attendance at a bureau of Indian education-funded high school at least three documented contact hours per day pursuant to 25 CFR 39.211(c); b. obtains permission from the LEA representative (in consultation with the student’s individualized education program team, as needed), the student’s parent or guardian if the student is under 18 years old, and POSTSECONDARY INSTITUTION representative prior to enrolling in a dual credit course; and c. meets POSTSECONDARY INSTITUTION requirements to enroll as a dual credit student.

  • Employment Verification Grantee will confirm the eligibility of all persons employed during the contract term to perform duties within Texas and all persons, including subcontractors, assigned by the contractor to perform work pursuant to the Contract.

  • Maintaining Eligibility for Employer Contribution The employer's contribution continues as long as the employee remains on the payroll in an insurance eligible position. Employees who complete their regular school year assignment shall receive coverage through August 31.

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