HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS Sample Clauses

HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS. 5.1 Payments to Provider. Subcontractor or Health Plan (as applicable) shall pay Provider on a timely basis as set forth in the Agreement, the applicable State Contract and applicable State and federal law and regulations, including but not limited to 42 U.S.C. 1396u-2(f) and 42 CFR 447.46, 42 CFR 447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6), as applicable and as may be amended from time to time. Unless a different timeframe is set forth in the Agreement, Subcontractor or Health Plan (as applicable) will pay 90% of claims from physicians in an individual or group practice which can be processed without obtaining additional information from the physician or from a third party within ninety (90) days of the date of receipt of the claim. If a third party liability exists, payment of claims shall be determined in accordance with federal and/or State third party liability law and the terms of the applicable State Contract. Unless Subcontractor or Health Plan (as applicable) otherwise requests assistance from Provider, Subcontractor or Health Plan will be responsible for third party collections in accordance with the terms of the applicable State Contract.
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HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS. 4.1 Prompt Payment. Subcontractor or Health Plan (as applicable) shall accept claims electronically by batch file upload or by direct data entry and pay Provider pursuant to the State Contract and applicable State and federal law and regulations, including but not limited to 42 CFR 447.46, 42 CFR 447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6), as applicable and as may be amended from time to time. If a third party liability exists, payment of claims shall be determined in accordance with federal and/or State third party liability law and the terms of the State Contract. Unless Subcontractor or Health Plan (as applicable) otherwise requests assistance from Provider, Subcontractor or Health Plan will be responsible for third party collections in accordance with the terms of the State Contract.
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HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS. 5.1 Prompt Payment. Subcontractor or Health Plan (as applicable) shall pay Provider pursuant to the State Contract and applicable State and federal law and regulations, including but not limited to 42 CFR 447.46, 42 CFR 447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6), as applicable and as may be amended from time to time. If a third party liability exists, payment of claims shall be determined in accordance with federal and/or State third party liability law and the terms of the State Contract. Unless Subcontractor or Health Plan (as applicable) otherwise requests assistance from Provider, Subcontractor or Health Plan will be responsible for third party collections in accordance with the terms of the State Contract. Subcontractor or Health Plan shall not be responsible for any payments owed to Provider for services that were rendered prior to a Covered Person’s enrollment, even if such services fell within any applicable period of retroactive eligibility for Medicaid. Subcontractor or Health Plan shall not be financially liable for services rendered to treat a non-emergent condition in a hospital emergency room (except to assess whether a condition warrants treatment as Emergency Services, or as required elsewhere in law), unless the services were prior authorized or otherwise conformed to the terms of the Agreement. Subcontractor or Health Plan shall not be liable to pay claims to Provider if the validity of the claim is being challenged by Subcontractor or Health Plan through a grievance or appeal, unless Subcontractor or Health Plan is obligated to pay the claim or a portion of the claim through the Agreement.
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HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS. 5.1. Prompt Payment. Health Plan or Subcontractor shall pay Provider pursuant to the applicable State Contract, applicable State law and regulations, and 42 CFR 447.46, 42 CFR 447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6), as applicable and as may be amended from time to time. If a third party liability exists, payment of claims shall be determined in accordance with federal and/or State third party liability law and the terms of the applicable State Contract. Unless Health Plan or Subcontractor otherwise requests assistance from Provider, Health Plan will be responsible for third party collections in accordance with the terms of the applicable State Contract.
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HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS. 5.1 Prompt Payment. Subcontractor or Health Plan (as applicable) shall pay Provider on a timely basis as set forth in the Agreement, the State Contract and applicable State and federal law and regulations, including but not limited to 42 U.S.C. 1396u-2(f) and 42 CFR 447.46, 42 CFR 447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6), as applicable and as may be amended from time to time. Subcontractor or Health Plan (as applicable) shall adjudicate (finalize as paid or denied adjudicated) for: (1) healthcare services within thirty (30) days from the date it receives the Clean Claim from Provider; (2) pharmacy services no later than eighteen (18) days of receipt if submitted electronically or twenty-one (21) days if submitted non-electronically. Subcontractor or Health Plan (as applicable) shall pay Provider interest at a rate 18% per annum on all Clean Claims that are not adjudicated within thirty (30) days. If a third party liability exists, payment of claims shall be determined in accordance with federal and/or State third party liability law and the terms of the State Contract. Unless Subcontractor or Health Plan (as applicable) otherwise requests assistance from Provider, Subcontractor or Health Plan (as applicable) will be responsible for third party collections in accordance with the terms of the State Contract.
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HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS. 4.1 Health Plan or Subcontractor shall pay Provider pursuant to the State Contract, applicable State law and regulations, and 42 CFR 447.46, 42 CFR 447.45(d)(2), 42 CFR 447.45(d)(3), 42 CFR 447.45(d)(5) and 42 CFR 447.45(d)(6), as applicable and as may be amended from time to time. Unless an alternative payment schedule is set forth in the Agreement, Health Plan or Subcontractor, as the case may be, shall pay 90% of all clean claims from Provider, within thirty (30) days of the date of receipt, and shall pay 99% of all clean claims from Provider within ninety (90) days of the date of receipt. The date of receipt is the date that Health Plan or Subcontractor, as the case may be, receives the claim, as indicated by its data stamp on the claim. The date of payment is the date of the check or other form of payment. If a third party liability exists, payment of claims shall be determined in accordance with federal and/or State third party liability law and the terms of the State Contract. Unless Health Plan or Subcontractor otherwise requests assistance from Provider, Health Plan will be responsible for third party collections in accordance with the terms of the State Contract. 4.2 Neither Health Plan nor Subcontractor shall prohibit or otherwise restrict Provider, when acting within the lawful scope of Provider’s license or certification under applicable State law, from advising a Covered Person about the Covered Person’s health status, medical care, or treatment for the Covered Person’s condition or disease, regardless of whether benefits for such care or treatment are provided under the Covered Person’s benefit plan. 4.3 Neither Health Plan nor Subcontractor shall discriminate with respect to participation, reimbursement, or indemnification of a provider who is acting within the scope of such provider’s license or certification under applicable State law, solely on the basis of such license or certification. This provision does not prohibit Health Plan from limiting its network to the extent necessary to serve Covered Persons’ needs and is not intended to, nor shall it interfere with, measures established by Health Plan or Subcontractor to maintain quality of care practice standards or control costs. 4.4 Neither Health Plan nor Subcontractor shall discriminate against Provider for serving high-risk Covered Persons or if Provider specializes in conditions requiring costly treatments. 4.5 In addition to Subcontractor’s termination rights under the Agreement, H...
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HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS 
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Related to HEALTH PLAN AND SUBCONTRACTOR REQUIREMENTS

  • Subcontractor Requirements The Supplier must ensure that any subcontract entered into for the purpose of this Agreement contains an equivalent clause granting the rights specified in this clause.

  • Contractor Requirements The Firm shall be construed, during the entire term of this contract, to be an independent contractor. Nothing in this contract is intended to nor shall be construed to create an employer- employee relationship, or a joint venture relationship. The Firm represents that it is qualified to perform the duties to be performed under this contract and that it has, or will secure, if needed, at its own expense, applicable personnel who are qualified to perform the duties required under this contract. Such personnel shall not be deemed in any way, directly or indirectly, expressly or by implication, to be employees of the District. Any person assigned by the firm to perform the services hereunder shall be the employee or a subcontractor of the Firm, who shall have the sole right to hire and discharge its employee or subcontractors. The Firm or its subcontractors shall pay, when due, all salaries and wages of their employees and accepts exclusive responsibility for the payment of federal income tax, social security, unemployment compensation and any other withholdings that may be required. Neither the Firm, its subcontractors nor their employees are entitled to state retirement or leave benefits. It is further understood that the consideration expressed herein constitutes full and complete compensation for all services and performance hereunder, and that any sum due and payable to the Firm shall be paid as a gross sum with no withholdings or deductions being made by the District for any purpose from said contract sum, except as permitted in paragraphs 16, 17 and 18.

  • Subcontractor Compliance The Recipient is responsible for Subrecipient compliance with the requirements of this clause and may be held liable for unpaid wages due Subrecipient workers.

  • Subcontractor Insurance Requirements Consultant shall require each of its subcontractors that perform services under this Agreement to maintain insurance coverage that meets all of the requirements of this Section 11.

  • Health Requirements A. Provider shall remain in compliance with all applicable federal, state, county, and municipal, statutes, laws, ordinances, regulations, and guidelines, as well as any Board guidelines, policies, and rules in effect now or later, and as amended from time to time related to COVID-19. B. Provider shall comply with evolving requirements to protect the health and safety of Student Participants and staff, as expressed in local, and state guidance from various government agencies. This includes, but is not limited to, adhering to all health and safety guidelines issued by CPS, IDPH, and CDPH related to COVID-19. Provider acknowledges these health and safety guidelines are subject to change. C. Required health and safety practices may vary across age groups and settings. Provider shall comply, at a minimum, with all health and safety mandates issued by the State of Illinois and the City of Chicago and guidance from the Illinois State Board of Education (“ISBE”). D. Under Chicago’s March 19 Public Health Order, congregate facilities (such as long-term care facilities, childcare settings, correctional facilities, etc.) must immediately report to CDPH clusters of COVID-19 patients, defined as two or more confirmed cases of COVID-19 occurring within 14 calendar days of each other at a facility. To report positive cases, Provider must complete the COVID-19 Online Case Report Form found at the following website: xxxxx://xxxxxx.xxx.xxxxxxxx.xxx/surveys/?s=FR7MAJAY84. A copy of the current COVID-19 Online Case Report Form is attached and incorporated into this Supplemental Scope as Attachment A. Provider must also comply with additional operational, reporting and tracing requirements established by CPS. E. As of July 13, 2020, interim guidance issued by CDPH encourages notification for every COVID-19 case. For more information, see CDPH Interim Guidance on Management of COVID 19 Cases in Childcare Settings (“CDPH Guidance”) at the following link: https://xxx.xxxxxxx.xxx/content/dam/city/depts/cdph/HealthProtectionandResponse/Interim% 20Guidance%20on%20Management%20of%20COVID 19%20Cases%20in%20Childcare%20Settings%2007.13.

  • Contractor Key Personnel ‌ The Contractor shall assign a Corporate OASIS SB Program Manager (COPM) and Corporate OASIS SB Contract Manager (COCM) as Contractor Key Personnel to represent the Contractor as primary points-of-contact to resolve issues, perform administrative duties, and other functions that may arise relating to OASIS SB and task orders solicited and awarded under OASIS SB. Additional Key Personnel requirements may be designated by the OCO at the task order level. There is no minimum qualification requirements established for Contractor Key Personnel. Additionally, Contractor Key Personnel do not have to be full-time positions; however, the Contractor Key Personnel are expected to be fully proficient in the performance of their duties. The Contractor shall ensure that the OASIS SB CO has current point-of-contact information for both the COPM and COCM. In the event of a change to Contractor Key Personnel, the Contractor shall notify the OASIS SB CO and provide all Point of Contact information for the new Key Personnel within 5 calendar days of the change. All costs associated with Contractor Key Personnel duties shall be handled in accordance with the Contractor’s standard accounting practices; however, no costs for Contractor Key Personnel may be billed to the OASIS Program Office. Failure of Contractor Key Personnel to effectively and efficiently perform their duties will be construed as conduct detrimental to contract performance and may result in activation of Dormant Status and/or Off-Ramping (See Sections H.16. and H.17.).

  • Quality Assurance Requirements There are no special Quality Assurance requirements under this Agreement.

  • Contractor Compliance Contractor represents and warrants to pay, at its sole expense, for all applicable permits, licenses, tariffs, tolls and fees to give all notices and comply with all laws, ordinances, rules and regulations of any governmental entity in conjunction with the performance of obligations under the Contract. Prior to award and during the Contract term and any renewals thereof, Contractor must establish to the satisfaction of the Commissioner that it meets or exceeds all requirements of the Bid/Contract and any applicable laws, including but not limited to, permits, insurance coverage, licensing, proof of coverage for worker’s compensation, and shall provide such proof as required by the Commissioner. Failure to do so may constitute grounds for the Commissioner to cancel or suspend this Contract, in whole or in part, or to take any other action deemed necessary by the Commissioner.

  • CONTRACT WORK HOURS AND SAFETY STANDARDS As per the Contract Work Hours and Safety Standards Act (40 U.S.C. 3701-3708), where applicable, all Customer Purchase Orders in excess of ,000 that involve the employment of mechanics or laborers must include a provision for compliance with 40 U.S.C. 3702 and 3704, as supplemented by Department of Labor regulations (29 CFR Part 5). Under 40 U.S.C. 3702 of the Act, each contractor must be required to compute the wages of every mechanic and laborer on the basis of a standard work week of 40 hours. Work in excess of the standard work week is permissible provided that the worker is compensated at a rate of not less than one and a half times the basic rate of pay for all hours worked in excess of 40 hours in the work week. The requirements of 40 U.S.C. 3704 are applicable to construction work and provide that no laborer or mechanic must be required to work in surroundings or under working conditions which are unsanitary, hazardous or dangerous. These requirements do not apply to the purchases of supplies or materials or articles ordinarily available on the open market, or contracts for transportation or transmission of intelligence.

  • Program Requirements The parties shall comply with the Disadvantaged Business Enterprise Program requirements established in 49 CFR Part 26.

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