Member Payment Liability Sample Clauses

Member Payment Liability. In accordance with 42 CFR 438.106, which relates to liability for payment, the Contractor and its subcontractors shall provide that members are not held liable for any of the following:  Any payments for covered services furnished under a contract, referral or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the Contractor provided the services directly;  Covered services provided to the member for which OMPP does not pay the Contractor;  Covered services provided to the member for which OMPP or the Contractor does not pay the provider that furnishes the services under a contractual, referral or other arrangement; and  The Contractor’s debts or subcontractor’s debts, in the event of the entity’s insolvency. The Contractor shall ensure that its providers do not balance xxxx its members, i.e., charge the member for covered services above the amount paid to the provider by the Contractor. If the Contractor is aware that an out-of-network, non-IHCP provider, such as an out-of-state emergency services provider, is balance billing a member, the Contractor shall instruct the provider to stop billing the member and to enroll in the IHCP in order to receive reimbursement from the Contractor. The Contractor shall also contact the member to help resolve issues related to the billing. IHCP providers are prohibited from charging a member, or the family of the member, for any amount not paid as billed for a covered IHCP service. Provider acceptance of payment from the Contractor as payment in full is a condition of participation in the IHCP. An IHCP provider can xxxx a member only when the following conditions have been met:  The service rendered must be determined to be non-covered by the IHCP;  The member has exceeded the program limitations for a particular service;  The member must understand, before receiving the service, that the service is not covered under the IHCP, and that the member is responsible for the charges associated with the service; and  The provider must maintain documentation that the member voluntarily chose to receive the service, knowing that the IHCP did not cover the service. A generic consent form is not acceptable unless it identifies the specific procedure to be performed, and the member signs the consent before receiving the service. See the IHCP Provider Manual for more information. In cases where prior authorization is denied, a provider can xxxx a member for covered se...

Member Payment Liability. Contractor and its Subcontractors shall ensure that Members are not held liable for any of the following:

Member Payment Liability. In accordance with 42 CFR 438.106, the MCO and its subcontractors are prohibited from holding members liable for: • Any payments for covered services furnished under a contract, referral or other arrangement, to the extent that those payments are in excess of the amount that the enrollee would owe if the MCO provided the services directly • Covered services provided to the member for which the State does not pay the MCO or for which the MCO or the State does not pay the provider • The MCO’s debts or subcontractor’s debts, in the event of the entity’s insolvency. The MCO must ensure that its providers do not balance xxxx its members, i.e., charge the member for covered services above the amount paid to the provider by the MCO.

Member Payment Liability. In accordance with 42 CFR 438.106, which relates to liability for payment, the Contractor and its subcontractors shall provide that members are not held liable for any of the following: Any payments for covered services furnished under a contract, referral or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the Contractor provided the services directly; Covered services provided to the member for which OMPP does not pay the Contractor; Covered services provided to the member for which OMPP or the Contractor does not pay the provider that furnishes the services under a contractual, referral or other arrangement; and