In-Network Provider Sample Clauses

In-Network Provider. (i) If Distributor is an in-network provider for a potential patient’s payor, Distributor shall offer to serve the prospective patient directly through Distributor’s retail pharmacy program. If the prospective patient accepts Distributor’s offer to serve, the prospective patient becomes a Patient (as that term is defined below)). If the prospective patient does not accept Distributor’s offer to serve, such prospective patient shall be transferred to the administrator of CTI’s Call Center and Reimbursement Support Services program in accordance with the procedure set forth below in Section 3.1.3(b). (ii) In accordance with a physician’s prescription, Distributor shall dispense and deliver the Product and Delivery Device to patients located in the Territory who are referred to Distributor by their treating physician or provider (hospital, outpatient clinic, infusion center, etc.) or by a managed care entity (“Patients”). (iii) Distributor shall deliver the Product and Delivery Device via Fed Ex, UPS or other common carrier at its option,standard overnight delivery service (or another mutually agreed to delivery service) to Patients at their home, or to any other location at which the Patient will receive inhalation therapy, such as a hospital, clinic or infusion center, all as designated by such Patient. Distributor shall track each shipment of Product and Delivery Device to Patients and confirm receipt. Distributor shall use its best efforts to dispense Product such that Product having the earliest expiration date is shipped first from available inventory. (iv) Distributor shall be responsible for all billing and collection in connection with its sales of Product and the Delivery Device to Patients. Distributor shall obtain a Patient’s authorization for Distributor to directly xxxx the Patient’s insurance company, government payor or other third party payor and to have such benefit payments made directly to Distributor. Distributor shall use reasonable efforts to obtain reimbursement clearance, if necessary, for anticipated subsequent orders from a Patient prior to actual receipt of the subsequent order. (v) Distributor shall ensure that a licensed pharmacist or nurse, to the extent permitted by law, who is properly trained to answer Product-related questions or requests for emergency supplies of Product, is available by telephone, on a designated toll-free number, (i) from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday, except Distributor holid...
Sample 1
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In-Network Provider. If Xxxx or any other provider performing Non-Member Services for you under this Agreement is a participating provider within your insurance or health plan network then, in exchange for the Non-Member Services selected by you and provided during the term of this Agreement, Xxxx or another provider performing the selected Non-Member Services will xxxx and attempt to collect applicable fees for such Non-Member Services from your insurer or health network. Other than copayment, which may be collected at the time of service depending on your insurance or health plan’s requirements, Xxxx or another provider performing the selected Non-Member Services will xxxx you after receiving the claims processing outcome for your Non-Member Services from your insurer or health plan. Such xxxx would reflect your payment obligations under your specific insurance or health plan and is to be paid within thirty (30) days. If you or Xxxx terminate this Agreement, these fees will not be refunded to you for any reason.
Sample 1

Related to In-Network Provider

  • NON-NETWORK PROVIDER is a provider that has not entered into a contract with us or any other Blue Cross and Blue Shield plan. For pediatric dental care services, non-network provider is a dentist that has not entered into a contract with us or does not participate in the Dental Coast to Coast Network. For pediatric vision hardware services, a non-network provider is a provider that has not entered into a contract with EyeMed, our vision care service manager.

  • Verizon OSS Services Access to Verizon Operations Support Systems functions. The term “Verizon OSS Services” includes, but is not limited to: (a) Verizon’s provision of ECI Usage Information to ECI pursuant to Section 8.3 of this Attachment; and, (b) “Verizon OSS Information”, as defined in Section 8.1.4 of this Attachment.

  • How Non-network Providers Are Paid If you receive care from a non-network provider, you are responsible for paying all charges for the services you received. You may submit a claim for reimbursement of the payments you made. For the limited circumstances listed below, your copayment and deductible will apply at the network level of benefits: • emergency care (emergency room, urgent care and ambulance services); • we specifically approve the use of a non-network provider for covered healthcare services, see Network Authorization in Section 5 for details; • covered healthcare services are rendered by a non-network provider at a network For those circumstances where we cover services from a non-network provider, we reimburse you or the non-network provider, less any copayments and deductibles, up to the lesser of: • our allowance; • the non-network provider’s charge; or • the benefit limit. You are responsible for the deductible, if one applies, and the copayment, as well as any amount over the benefit limit that applies to the service you received. You are liable for the difference between the amount that the non-network provider bills and the payment we make for covered healthcare services. Generally, we send reimbursement to you, but we reserve the right to reimburse a non-network provider directly. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. If an allowance for a specific covered healthcare service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. For emergency services, we reimburse non- network providers, in accordance with R.I. Gen. Laws § 27-18-76, the greater of our allowance, our usual guidelines for paying non-network providers, or the amount that would be paid under Medicare, less any copayments or deductibles. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the R.I. General Law §27-20-49 (Dental Insurance assignment of benefits) applies. For information about network authorization requests to seek covered healthcare services from a non-network provider when the covered healthcare service cannot be provided by a network provider, please see Network Authorization in Section 5.

  • The Web Services E-Verify Employer Agent agrees to, consistent with applicable laws, regulations, and policies, commit sufficient personnel and resources to meet the requirements of this MOU.

  • Service Management Effective support of in-scope services is a result of maintaining consistent service levels. The following sections provide relevant details on service availability, monitoring of in-scope services and related components.

  • Hosting Services NCR Voyix shall furnish facilities, equipment, computer programs and services, as specified from time to time by NCR Voyix, that NCR Voyix deems necessary for operation and maintenance of the System (collectively, the “Hosting Services”).

  • Program Manager Owner may designate a Program Manager to administer the Project and this Contract. In lieu of a Program Manager, Design Professional may be designated to perform the role of Program Manager. The Program Manager may also be designated as the Owner’s Representative, and if no Owner’s Representative is designated, the Program Manager shall be the Owner’s Representative.

  • Managed Services HP will provide the services as described in a Statement of Work (“SOW”) attached to this Agreement or incorporating it by reference. Each party will appoint a single point of contact as set forth in the SOW who will serve as their primary representative, have overall responsibility for managing performance, and meet with the other party’s representative to review progress. Change requests are governed by the change management procedures as set forth in the SOW.

  • Information Management Information and Records

  • Network Services Local Access Services In lieu of any other rates and discounts, Customer will pay fixed monthly recurring local loop charges ranging from $1,200 to $2,000 for TDM-based DS-3 Network Services Local Access Services at 2 CLLI codes mutually agreed upon by Customer and Company.

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