Eligibility Determinations. Provider or Contracted Provider shall timely verify whether an individual seeking Covered Services is a Covered Person. Company or Payor, as applicable, will make available to Provider and Contracted Providers a method, whereby Provider and Contracted Providers can obtain, in a timely manner, general information about eligibility and coverage. Company or Payor, as applicable, does not guarantee that persons identified as Covered Persons are eligible for benefits or that all services or supplies are Covered Services. If Company, Payor or its delegate determines that an individual was not a Covered Person at the time services were rendered, such services shall not be eligible for payment under this Agreement. In addition, Company will use reasonable efforts to include or contractually require Payors to clearly display Company’s name, logo or mailing address (or other identifier(s) designated from time to time by Company) on each membership card.
Eligibility Determinations. (1) General rules regarding eligibility determinations (a) Upon completing the administration of tests and other evaluation materials, a group of qualified professionals and the parent of the child must determine whether the child is a child with a disability, as defined in 34 CFR Sec. 300.8 and Paragraph (2) of Subsection B of 6.
Eligibility Determinations. It shall be the sole responsibility of the Department to determine the criteria for the initial and continuing eligibility of clients for the services provided under this agreement; provided, however that the Vendor, for cause shown and subject to the HEARING & GRIEVANCE PROCEDURES set forth below, many deny further service to any eligible person.
Eligibility Determinations. The Division will be responsible for confirming the eligibility of Enrollees for enrollment in the Plan. The Division will re-determine eligibility annually and will provide the Contractor with information relative to each Enrollee's continued eligibility for enrollment.
Eligibility Determinations. If any load is determined to contain material that does not conform to the definition of eligible debris, the load will be ordered to be deposited at another landfill or receiving facility and no payment will be allowed for that load and the Contractor will not invoice the City for such loads.
Eligibility Determinations. ABD Related. Eligibility determinations for ABD related populations in the community must follow the income and resource methodologies of the SSI program and the current Medicaid state plan.
Eligibility Determinations. CMS and RI EOHHS shall have sole responsibility for determining the eligibility of an Eligible Beneficiary for Medicare- and Medicaid-funded services. CMS and RI EOHHS shall have sole responsibility for determining Enrollment in the Contractor’s MMP.
Eligibility Determinations. 2.3.1.1. CMS and HHSC shall have sole responsibility for determining the eligibility of an Enrollee for Medicare- and Medicaid- funded services. CMS and HHSC or their designees shall have sole responsibility for determining Enrollment in the STAR+PLUS MMP’s plan.
2.3.1.2. CMS and the State will utilize an independent third-party entity to facilitate all Enrollment into the STAR+PLUS MMPs.
2.3.1.3. All Enrollment and disenrollment transactions, including Enrollments from one STAR+PLUS MMP to a different STAR+PLUS MMP, will be processed through the Administrative Services Contractor except those transactions related to non-Demonstration plan participating in Medicare Advantage.
0.0.0.0. XXXX+PLUS MMP Enrollments, including Enrollment from one STAR+PLUS MMP to a different STAR+PLUS MMP, and Opt-Outs shall become effective on the same day for both Medicare and Medicaid.
2.3.1.5. For those who lose Medicaid eligibility during the month, coverage and federal financial participation (FFP) will continue through the end of that month.
0.0.0.0. Xx addition to the groups listed in the MOU between Texas and CMS signed May 23, 2014, individuals with Third Party Health Insurance will be ineligible for Enrollment in a STAR+PLUS MMP.
Eligibility Determinations. Company shall have the right to recover payments made to Provider if the payments are for services provided to an individual who is later determined to have been ineligible based upon information that is not available to Company at the time the service is rendered or authorization is provided.
Eligibility Determinations. CMS and MDCH shall have sole responsibility for determining the eligibility of individuals for Medicare- and Medicaid- funded services. CMS and MDCH shall have sole responsibility for determining Enrollment in the ICO.
