Enrollee Billing, Generally Sample Clauses

Enrollee Billing, Generally. (A) Except as otherwise provided for in this Contract, no claim for payment shall be made at any time by the Contractor or its Participating Providers to an Enrollee accepted by that Participating Provider as an Enrollee for any Covered Service. (B) When a Provider accepts an Enrollee as a patient he or she shall look solely to the Contractor and any third party coverage for reimbursement. If the Provider fails to receive payment from the Contractor, the Enrollee cannot be held responsible for these payments.
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Enrollee Billing, Generally. (A) No claim for payment, except for co-payments, deductibles, and co-insurance will be made by the Contractor or Provider from the Enrollee for Covered Services.
Enrollee Billing, Generally. Except as otherwise provided for in this Contract, the Contractor or its Participating Providers shall not submit any claim for payment to an Enrollee who has been accepted by that Participating Provider as an Enrollee for any Covered Service.
Enrollee Billing, Generally. Except as otherwise provided for in this Contract, no claim for payment shall be made at any time by the Contractor or its Network Providers to an Enrollee accepted by that Network Provider as an Enrollee for any Covered Service.

Related to Enrollee Billing, Generally

  • Contractor Sales Reporting Vendor Management Fee Contractor Reports Cooperative Master Contract Sales Reporting. Contractor shall report total Cooperative Master Contract sales quarterly to Enterprise Services, as set forth below. Cooperative Master Contract Sales Reporting System. Contractor shall report quarterly Cooperative Master Contract sales in Enterprise Services’ Cooperative Master Contract Sales Reporting System. Enterprise Services will provide Contractor with a login password and a vendor number. The password and vendor number will be provided to the Sales Reporting Representative(s) listed on Contractor’s Bidder Profile. Data. Each sales report must identify every authorized Purchaser by name as it is known to Enterprise Services and its total combined sales amount invoiced during the reporting period (i.e., sales of an entire agency or political subdivision, not its individual subsections). The “Miscellaneous” option may be used only with prior approval by Enterprise Services. Upon request, Contractor shall provide contact information for all authorized Purchasers specified herein during the term of the Cooperative Master Contract. If there are no Cooperative Master Contract sales during the reporting period, Contractor must report zero sales. Due dates for Cooperative Master Contract Sales Reporting. Quarterly Cooperative Master Contract Sales Reports must be submitted electronically by the following deadlines for all Cooperative Master Contract sales invoiced during the applicable calendar quarter: Vendor Management Fee. Contractor shall pay to Enterprise Services a vendor management fee (“VMF”) of 1.5 percent on the purchase price for all Cooperative Master Contract sales (the purchase price is the total invoice price less applicable sales tax). The sum owed by Contractor to Enterprise Services as a result of the VMF is calculated as follows: Amount owed to Enterprise Services = Total Cooperative Master Contract sales invoiced (not including sales tax) x .015. The VMF must be rolled into Contractor’s current pricing. The VMF must not be shown as a separate line item on any invoice unless specifically requested and approved by Enterprise Services. Enterprise Services will invoice Contractor quarterly based on Cooperative Master Contract sales reported by Contractor. Contractor is not to remit payment until Contractor receives an invoice from Enterprise Services. Contractor’s VMF payment to Enterprise Services must reference this Cooperative Master Contract number, the year and quarter for which the VMF is being remitted, and Contractor’s name as set forth in this Cooperative Master Contract, if not already included on the face of the check. Contractor’s failure to report accurate total net Cooperative Master Contract sales, to submit a timely Cooperative Master Contract sales report, or to remit timely payment of the VMF to Enterprise Services, may be cause for Enterprise Services to suspend Contractor or terminate this Cooperative Master Contract or exercise remedies provided by law. Without limiting any other available remedies, the parties agree that Contractor’s failure to remit to Enterprise Services timely payment of the VMF shall obligate Contractor to pay to Enterprise Services, to offset the administrative and transaction costs incurred by the State to identify, process, and collect such sums, the sum of $200.00 or twenty-five percent (25%) of the outstanding amount, whichever is greater, or the maximum allowed by law, if less. Enterprise Services reserves the right, upon thirty (30) calendar days advance written notice, to increase, reduce, or eliminate the VMF for subsequent purchases, and reserves the right to renegotiate Cooperative Master Contract pricing with Contractor when any subsequent adjustment of the VMF might justify a change in pricing. Annual Cooperative Master Contract Sales Report. Contractor shall provide to Enterprise Services a detailed annual Cooperative Master Contract sales report. Such report shall include, at a minimum: the Goods/Services sold (including, as applicable, item number or other identifier), per unit quantities sold, items and volumes purchased by Purchaser, shipment/delivery locations by Purchaser, and Cooperative Master Contract price. This report must be provided in an electronic format that can be read by Microsoft (MS) Excel. Such report is due within thirty (30) calendar days of the annual anniversary of the effective date of this Cooperative Master Contract.

  • STATEWIDE CONTRACT MANAGEMENT SYSTEM If the maximum amount payable to Contractor under this Contract is $100,000 or greater, either on the Effective Date or at any time thereafter, this section shall apply. Contractor agrees to be governed by and comply with the provisions of §§00-000-000, 00-000-000, 00-000-000, and 00- 000-000, C.R.S. regarding the monitoring of vendor performance and the reporting of contract information in the State’s contract management system (“Contract Management System” or “CMS”). Contractor’s performance shall be subject to evaluation and review in accordance with the terms and conditions of this Contract, Colorado statutes governing CMS, and State Fiscal Rules and State Controller policies.

  • Processing Grievances The grievant shall be granted reasonable time off with pay from regularly scheduled duty hours to process a grievance, provided that the time off will be devoted to the prompt and efficient investigation and handling of grievances, subject to the following: Neither a grievant nor a grievant's representative who is a Court employee shall suffer any lost pay for attending any regularly scheduled grievance hearing required by the procedure herein set forth. A. A grievant and a grievant's representative shall notify their supervisor as soon as possible of scheduled grievance hearings and of any changes in the time or date of scheduled hearings in which they must participate. B. In no event shall a grievant be represented by more than one Court employee at a grievance hearing.

  • Statewide HUB Program Statewide Procurement Division Note: In order for State agencies and institutions of higher education (universities) to be credited for utilizing this business as a HUB, they must award payment under the Certificate/VID Number identified above. Agencies, universities and prime contractors are encouraged to verify the company’s HUB certification prior to issuing a notice of award by accessing the Internet (xxxxx://xxxxx.xxx.xxxxx.xx.xx/tpasscmblsearch/index.jsp) or by contacting

  • Sick Leave Verification Process a. The new school district shall provide the employee with the necessary verification form at the time the employee receives confirmation of employment in the school district. b. An employee must initiate the sick leave verification process and forward the necessary verification forms to the previous school district(s) within ninety (90) days of commencing employment with the new school district. c. The previous school district(s) shall make every reasonable effort to retrieve and verify the sick leave credits which the employee seeks to port.

  • Prices and Services Billing 8.1 SCHEDULE OF PRICES AND TERMS Competitive Supplier agrees to provide Firm Full-Requirements Power Supply and other related services as expressly set forth herein in accordance with the prices and terms included in EXHIBIT A to this ESA, which exhibit is hereby incorporated by reference into this ESA.

  • Seniority Verification Process i. The new school district shall provide the employee with the necessary verification form at the time the employee achieves continuing contract status. ii. The employee must initiate the seniority verification process and forward the necessary verification forms to the previous school district(s) within ninety (90) days of receiving a continuing appointment in the new school district. iii. The previous school district(s) shall make every reasonable effort to retrieve and verify the seniority credits which the employee seeks to port.

  • FINAL BILLING SUBMISSION Unless otherwise provided by the System Agency, Grantee shall submit a reimbursement or payment request as a final close-out invoice not later than forty-five (45) calendar days following the end of the term of the Contract. Reimbursement or payment requests received after the deadline may not be paid.

  • Customer Service Standards The Franchising Authority hereby adopts the customer service standards set forth in Part 76, §76.309 of the FCC’s rules and regulations, as amended. The Grantee shall comply in all respects with the customer service requirements established by the FCC.

  • Classification Review (A) Reclassification Request (a) An employee who has good reason to believe that they are improperly classified may apply, in writing by electronic mail, to their immediate out-of-scope Manager to have their classification reviewed. This may occur when there has been a substantive change in the job functions, when there has been a change in organizational structure that significantly impacts roles, or when a classification specification has been amended in a manner that alters the basis on which classification levels are differentiated. The employee making the request will indicate the reason(s) why they believe their position is inappropriately classified, including the changes that have occurred to the position, organization or classification specifications. In some circumstances, a classification review may be initiated in response to a long standing perceived inequity in how a position is classified. However, where a review has been previously conducted, employees should not request a subsequent classification review unless there has been a substantive change as described above. Submissions must include an approved job description, in the event that a current job description is not available an employee can initiate their written request so as to establish a potential effective date as per article 40.04(a). The manager shall send a copy of the employee’s request to Human Resources without delay, and shall confirm in writing to the employee and the Union that the employee’s request has been received. The manager shall advise the employee of the results of the classification review within ninety (90) calendar days of receiving the request. The notification shall be in writing and include rationale for the decision, specifically addressing the reasons for the review provided by the employee. (b) When reviewing a request for reclassification, the Employer shall follow the guidelines included in the Classification Specification User Manual. Requests are reviewed by the Employer. The evaluation of the role may include an audit of the role, including interviews with the Employee and the Employee’s Manager as needed. (c) Should the employee feel that they have not received proper consideration in regard to a classification review, they may request that the matter be referred to the Internal Appeal Process.

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