Eligibility Data Sample Clauses

Eligibility Data. TennCare shall make all reasonable efforts to supply Medicaid eligibility information upon the receipt of the request from the Contractor using a “realtime” access method chosen from the options described below. The Contractor shall pay for access and use of this data, according to the option chosen in Section C, Payment Terms and Conditions: The choice of method shall be binding for the term of this Contract from signing by both parties, unless TennCare agrees to allow a mid-term change. Such agreement shall not be unreasonably withheld. In the event of such a change, the Contractor shall agree to abide by all timelines, testing procedures and any other requirements mandated by TennCare to make the changeover. Once data interface as specified in Section A.2.c.3. is tested and approved by TennCare for implementation, the Contractor shall no longer rely on TNAnytime for access to eligibility data. The data shall be submitted by TennCare and loaded by the Contractor.
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Eligibility Data. Company may provide BetterUp with a list of its employees and contact details (“Eligibility Data”) to verify eligibility to use the BetterUp Platform through Company’s relationship with BetterUp.
Sample 1
Eligibility Data. Plan Sponsor shall provide to ProAct all information concerning the Prescription Benefit Plan and Plan Participants necessary for ProAct to perform the Prescription Drug Services, including all updates thereto, on a daily basis and at least fourteen (14) days prior to the Implementation Date. Plan Sponsor shall be responsible for ensuring the accuracy of the Eligible Member List and Plan Sponsor shall be obligated to pay ProAct for Claims accepted by ProAct that are submitted by or on behalf of persons listed on any Plan Participants List. Plan Sponsor shall bear the entire risk of all fraudulent Claims submitted by Plan Participants or by unauthorized persons using a Plan Participant’s ID Card or identification number. The Plan Participant List shall contain the following minimum information: • Plan Participant's identification number; • Plan Participant’s full name (last, first, and middle initial); • Plan Participant’s date of birth; • Plan Participant’s address; • the names of dependents; • the dates of birth for dependents; • the date the Plan Participant’s participation in Prescription Drug Services under the Benefit Plan becomes effective; • the date the Plan Participant’s participation in Prescription Drug Services under the Benefit Plan is terminated; • the Benefit Plan group number Plan Sponsor agrees to indemnify ProAct for any damages related to Plan Sponsor’s failure to provide accurate and timely data described in this Section 4.1.
Sample 1
Eligibility Data. C.12.2.1 The Contractor's enrollment system shall be capable of linking records for the same Enrollee that are associated with different Medicaid identification numbers, e.g., Enrollees who are re-enrolled and assigned new numbers. C.12.2.2 A Contractor operating a District of Columbia DCHFP and a CASSIP shall have a method linking the records of an Enrollee who is disenrolled from the DCHFP and enrolled in the CASSIP or vice versa. C.12.2.3 At the time of service, the Contractor or its subcontractors shall verify every Enrollee's eligibility through the Eligibility Verification System (EVS) operated by the District. C.12.2.4 The Contractor shall update its eligibility database whenever Enrollees change names, phone numbers, and/or addresses, and shall notify the District of such changes. -------------------------------------------------------------------------------- CONTRACT NO.: P0HC-2002-D-0003 107 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- C.12.2.5 The Contractor shall notify the MAA of any Enrollees for whom accurate addresses or current locations cannot be determined and shall document the action that has been taken to locate the Enrollees. The Contractor shall notify the MAA of the known deaths of any Enrollees within two (2) business days.
Sample 1
Eligibility Data. All Service Fees paid hereunder shall be sent with a file in a format acceptable to Health Advocate with sufficient and accurate data for Health Advocate to effectively and efficiently authenticate and track utilization of EAP Members. Client acknowledges that Health Advocate’s ability to perform Services hereunder, including but not limited to, user registration and utilization reporting, is directly related to the sufficiency, timeliness and accuracy of data provided by Client to Health Advocate.
Sample 1
Eligibility Data. (a) Participating Group, or Participating Group’s designee, at Participating Group’s sole expense, will provide Caremark all information concerning its Plan and Plan Participants needed to perform the Services, including any updates thereto (“Eligibility Information”). This Eligibility Information must be complete and accurate, provided timely, and in a format and media acceptable by Caremark. (b) Caremark will maintain the Eligibility Information provided by Participating Group. (c) Caremark, Plan Participants’ physicians and the Participating Pharmacies are entitled to rely on the accuracy and completeness of the Eligibility Information and updates thereto. (d) Caremark is not liable for fraudulent Claims submitted by Plan Participants or by unauthorized persons using a Plan Participant’s identification card or number.
Sample 1
Eligibility Data. The State will provide Pharmacy Benefit Manager (either directly or through an authorized third party administrator) with a weekly eligibility file, in a format mutually agreed upon by the Parties. The State will provide timely eligibility updates (for example, additions, terminations, change of address or personal information, etc.) to ensure accurate determination of the eligibility status of Member. The State acknowledges that: (a) Pharmacy Benefit Manager provides such eligibility data to the Participating Pharmacies and understands that Pharmacy Benefit Manager and Participating Pharmacies will act in reliance upon the accuracy of data received from State; (b) Pharmacy Benefit Manager will continue to rely on the information provided by State until Pharmacy Benefit Manager receives notice that such information has changed; and (c) Pharmacy Benefit Manager will not be liable to the State for any Claims or expense resulting from the provision by the State (or its designees) of inaccurate, erroneous, or untimely information. In lieu of the eligibility file, the State may provide eligibility information by updating the claims adjudication system of Pharmacy Benefit Manager directly (except for the initial eligibility file, which must be provided to Pharmacy Benefit Manager during the initial implementation), provided the State continues to meet Pharmacy Benefit Manager’s conditions and specifications for direct eligibility updates.
Sample 1
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Eligibility Data. You acknowledge that the account data contained in Exhibit H is complete and accurate and that US Solar may use the data for purposes of confirming your conformance with the applicable Eligibility Requirements. You agree to provide US Solar and the applicable Project Owner with any additional information we request to determine, verify, or confirm your eligibility at any time during the Term.
Sample 1
Eligibility Data. CarePlus or its designated agent shall furnish Participating Provider with Enrollee eligibility data in an agreed upon electronic medium in the format requested by Participating Provider. CarePlus shall provide the initial test data tape forty-five (45) days prior to implementation of services for CarePlus and the initial full data tape seven (7) days prior to implementation for CarePlus. If CarePlus submits eligibility data in a format other than that requested by Participating Provider, CarePlus shall incur a programming fee at Participating Provider's then prevailing rate payable within ten (10) days of date of invoice. Thereafter, CarePlus shall furnish Participating Provider with eligibility updates on a daily or at least a weekly basis. Such data shall identify all Enrollees for that month, data on any changes, additions or terminations of Enrollees. CarePlus agrees that Participating Provider may rely upon the accuracy of all data received from CarePlus. CarePlus shall be responsible for notifying Participating Provider of an Enrollee's termination from coverage.
Sample 1

Related to Eligibility Data

  • Program Eligibility The COUNTY shall provide eligibility determination for those persons applying for home repair under this Agreement by using the following factors: 1. The applicant is a resident of the CITY; and 2. The total income for all members of the applicant’s household does not exceed 80% of the median income of the Kansas City metropolitan area, as determined by the Secretary of Housing and Urban Development; and 3. The applicant is the homeowner and must have occupied the property as a primary residence for at least six (6) months; 4. The property to be repaired is within the corporate limits of the CITY; and 5. When required, medical need will be substantiated and documented.

  • 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.

  • Member Eligibility Verify Member eligibility contemporaneous with the rendering of services. BCBS will provide systems and/or methods for verification of eligibility and benefit coverage for Members. This is furnished as a service and not as a guarantee of payment;

  • 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: 2.3.3.1 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; 2.3.3.2 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; 2.3.3.3 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 to the CMO plan that has the lowest capitated rates in the Service Region. 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 on quality measures to be defined by DCH. This factor will be applied after determining that there are no Historical Provider Relationships, but prior to utilizing the lowest Capitation rates criteria. 2.3.6 In the Xxxxxxx Xxxxxxx Xxxxxx, XXX will limit enrollment in a single plan to no more than forty percent (40%) of total GF eligible lives in the Service Region. Members will not be Auto-Assigned to a CMO plan 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 Atlanta Service Region. DCH may, at its sole discretion, elect to modify this threshold for reasons it deems necessary and proper. 2.3.7 In the five (5) Service Regions other than Atlanta DCH will limit Enrollment in a single plan to no more than sixty-five percent (65%) of total GF eligible lives in the Service Region. Members will not be Auto-Assigned to a CMO plan 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. Enrollment limits will be figured once per quarter at the beginning of each quarter. 2.3.8 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. 2.3.9 DCH or its Agent will be responsible for the consecutive Enrollment period and re-Enrollment functions. 2.3.10 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. 2.3.11 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. 2.3.12 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. 2.3.13 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. 2.3.14 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. 2.3.15 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.

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

  • Contribution Eligibility You are eligible to make a regular contribution to your Xxxx XXX, regardless of your age, if you have compensation and your MAGI is below the maximum threshold. Your Xxxx XXX contribution is not limited by your participation in an employer-sponsored retirement plan, other than a Traditional IRA.

  • General Eligibility i. A teacher who received an evaluation rating of ineffective or improvement necessary in the prior school year is not eligible for any salary increase and remains at their prior year salary.

  • TAX LIMITATION ELIGIBILITY In order to be eligible and entitled to receive the value limitation identified in Section 2.4 for the Qualified Property identified in Article III, the Applicant shall: A. have completed the Applicant’s Qualified Investment in the amount of $30,000,000 during the Qualifying Time Period; B. have created and maintained, subject to the provisions of Section 313.0276 of the TEXAS TAX CODE, New Qualifying Jobs as required by the Act; and C. pay an average weekly wage of at least $1,185.50 for all New Non-Qualifying Jobs created by the Applicant.

  • Eligibility It will notify the Issuer and the Servicer promptly if it no longer meets the eligibility requirements in Section 5.1.

  • S-3 Eligibility (i) At the time of filing the Registration Statement and (ii) at the time of the most recent amendment thereto for the purposes of complying with Section 10(a)(3) of the Securities Act (whether such amendment was by post-effective amendment, incorporated report filed pursuant to Section 13 or 15(d) of the Exchange Act or form of prospectus), the Company met the then applicable requirements for use of Form S-3 under the Securities Act, including compliance with General Instruction I.B.1 of Form S-3.

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