Encounter Data Submission Penalties Sample Clauses

Encounter Data Submission Penalties. Based on Blue Shield’s quarterly determinations and following no less than thirty (30) days prior notice to Group, Blue Shield may withhold a portion of Group’s Capitation, as set forth in Exhibit C., in the event that Blue Shield determines that a significant portion (as described in the Provider Manual) of the monthly Encounter Data which Group is obligated to provide (Paragraph 2.12) has not been delivered to Blue Shield within the prior quarter. If at the quarterly determination next following such withhold, Blue Shield determines that Group has satisfactorily delivered to Blue Shield the previously non-delivered Encounter Data, such withheld Capitation shall be paid to Group, without interest. In the event that Group does not deliver such Encounter Data to Blue Shield prior to such quarterly determination, Blue Shield shall be entitled to retain such withheld Capitation and will continue to deduct from the Group’s Capitation and retain such deductions as described in Exhibit C. from each quarter’s Capitation. If at a later date Group resumes the timely and complete submission of encounter data as required by this Agreement, then Blue Shield will cease deducting these penalties from Group’s Capitation beginning as of the month in which compliance is demonstrated by Group.
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Encounter Data Submission Penalties. In the event that Group fails to comply with the encounter data submission requirements described in Paragraph 2.12 hereof, then the amounts to be deducted or withheld from Group’ Capitation on a monthly basis as provided in Paragraph 7.11 hereof are identified in Exhibit C-l as “Penalties for Deficient Encounter Data Submission”.
Sample 1
Encounter Data Submission Penalties. In the event that Group fails to comply with the encounter data submission requirements described in Paragraph 2.12 hereof, then the amounts to be deducted or withheld from Group’ Capitation on a monthly basis as provided in Paragraph 7.11 hereof are identified in Exhibit C-l as “Penalties for Deficient Encounter Data Submission”. As of 01/01/2003, the effective net yield (which includes the deduction for Stop Loss, if applicable) for the following PMPMs and factors are *** for the HMO Group, *** for HMO IFP, *** for POS, and *** pmpm in aggregate, based on the 08/01/2002 membership.
Sample 1

Related to Encounter Data Submission Penalties

  • Encounter Data Party shall provide encounter data to the Agency of Human Services and/or its departments and ensure further that the data and services provided can be linked to and supported by enrollee eligibility files maintained by the State.

  • Claims Review Population A description of the Population subject to the Claims Review.

  • Claims Review Methodology ‌‌ a. C laims Review Population. A description of the Population subject‌‌ to the Quarterly Claims Review.

  • Claims Submission Unless otherwise prohibited by federal or state law, Provider will submit Clean Claims for all Covered Services to BCBSM within one hundred eighty (180) days of the date of service.

  • Submitting False Claims; Monetary Penalties The AOC shall be entitled to remedy any false claims, as defined in California Government Code section 12650 et seq., made to the AOC by the Contractor or any Subcontractor under the standards set forth in Government Code section 12650 et seq. Any Contractor or Subcontractor who submits a false claim shall be liable to the AOC for three times the amount of damages that the AOC sustains because of the false claim. A Contractor or Subcontractor who submits a false claim shall also be liable to the AOC for (a) the costs, including attorney fees, of a civil action brought to recover any of those penalties or damages, and (b) a civil penalty of up to $10,000 for each false claim.

  • ADB’s Review of Procurement Decisions 11. All contracts procured under international competitive bidding procedures and contracts for consulting services shall be subject to prior review by ADB, unless otherwise agreed between the Borrower and ADB and set forth in the Procurement Plan.

  • Review Protocol A narrative description of how the Claims Review was conducted and what was evaluated.

  • Invoice Submission All invoices submitted by Contractor shall include the City Contract Number, an assigned Invoice Number, and an Invoice Date. Contractor shall be provided with a cover sheet for invoicing. This cover sheet must be filled out correctly and submitted with each invoice. Contractor shall submit the original invoice through the responsible City Project Manager at: City of Ocala Engineer’s Office, Attn: Xxxxx Xxxxxxxxxx, 0000 XX 00xx Xxxxxx, Xxxxxxxx 000, Xxxxx, Xxxxxxx 00000, E-Mail: xxxxxxxxxxx@xxxxxxx.xxx.

  • Stipulated Penalties Review Notwithstanding any provision of Title 42 of the United States Code or Title 42 of the Code of Federal Regulations, the only issues in a proceeding for Stipulated Penalties under this CIA shall be: (a) whether Good Shepherd was in full and timely compliance with the obligations of this CIA for which OIG demands payment; and (b) the period of noncompliance. Good Shepherd shall have the burden of proving its full and timely compliance and the steps taken to cure the noncompliance, if any. OIG shall not have the right to appeal to the DAB an adverse ALJ decision related to Stipulated Penalties. If the ALJ agrees with OIG with regard to a finding of a breach of this CIA and orders Good Shepherd to pay Stipulated Penalties, such Stipulated Penalties shall become due and payable 20 days after the ALJ issues such a decision unless Good Shepherd requests review of the ALJ decision by the DAB. If the ALJ decision is properly appealed to the DAB and the DAB upholds the determination of OIG, the Stipulated Penalties shall become due and payable 20 days after the DAB issues its decision.

  • Third Party Administrators for Defined Contribution Plans 2.1 The Fund may decide to make available to certain of its customers, a qualified plan program (the “Program”) pursuant to which the customers (“Employers”) may adopt certain plans of deferred compensation (“Plan or Plans”) for the benefit of the individual Plan participant (the “Plan Participant”), such Plan(s) being qualified under Section 401(a) of the Code and administered by TPAs which may be plan administrators as defined in the Employee Retirement Income Security Act of 1974, as amended. 2.2 In accordance with the procedures established in Schedule 2.1 entitled “Third Party Administrator Procedures,” as may be amended by the Transfer Agent and the Fund from time to time (“Schedule 2.1”), the Transfer Agent shall: (a) Treat Shareholder accounts established by the Plans in the name of the Trustees, Plans or TPAs, as the case may be, as omnibus accounts; (b) Maintain omnibus accounts on its records in the name of the TPA or its designee as the Trustee for the benefit of the Plan; and (c) Perform all Services under Section 1 as transfer agent of the Funds and not as a record-keeper for the Plans. 2.3 Transactions identified under Sections 1 and 2 of this Agreement shall be deemed exception services (“Exception Services”) when such transactions: (a) Require the Transfer Agent to use methods and procedures other than those usually employed by the Transfer Agent to perform transfer agency and recordkeeping services; (b) Involve the provision of information to the Transfer Agent after the commencement of the nightly processing cycle of the TA2000 System; or (c) Require more manual intervention by the Transfer Agent, either in the entry of data or in the modification or amendment of reports generated by the TA2000 System, than is normally required.

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