Parts 160 and 164. Loss of Eligibility Date. Eligibility of Employee shall terminate on the last day for which Premium is paid for them, or on n/a as specified by Company whichever occurs first. Eligibility of Dependents, including spouses, shall terminate at the same time or on the day they no longer qualify as a Dependent. Maximum Plan Allowance shall mean the amount payable for Services of Participating and Non- Participating Dentists, calculated by Delta Dental, for use in payment by it and by its Enrollees from claim charges submitted, on a regional basis, for a given Service by Dentists of similar training within the same geographical area blended by Delta Dental with dentist fee information from a number of other sources, including dentist fee filings, using various factors, subject to regulatory limitations and adjustment for extreme difficulty or unusual circumstances. Any adjustments made for regulatory limitations or for extreme difficulty or unusual circumstances shall be made in favor of the enrollee. National Provider File shall mean the file maintained by Delta Dental Plans Association listing maximum allowable amounts or equivalents per procedure, by product and network status used by Delta Dental Plans.
Parts 160 and 164. In cases where PHI may occasionally need to be disclosed from VA to the Academic Institution, this will only be done with the applicable authority under the Privacy Rule as well as other VA privacy statutes. Shared HPTs or shared faculty members may need to submit PHI directly to the Academic Institution. Both the VA medical center and the Academic Institution agree to: • Utilize de-identified data (whether in electronic or paper format) wherever possible in this relationship, • Protect individually identifiable health information by securely managing the confidentiality, integrity, and availability of PHI, • Implement appropriate administrative, physical, and technical safeguards and controls to protect PHI and document applicable policies and procedures to prevent any Use or Disclosure of PHI other than as allowed under the authority of all applicable VA privacy statutes such as the Privacy Act, 38 U.S.C. § 7332, 38 U.S.C. § 5705, 38 U.S.C. § 5701 and all HIPAA regulations, • Not use or further disclose PHI other than as permitted or required by this agreement or as required by law, • Report to the other party (and to its own HIPAA Privacy Officer) all security incidents involving PHI within 24 hours of discovery. The reports shall be sent by e-mail to the appropriate representative, as identified by each party. With respect to any such possible incidents, each party shall comply with all applicable reporting, individual notification, and mitigation requirements under VA policy.
Parts 160 and 164. (a) Breach, as used in Section 2 of this Agreement, means the unauthorized acquisition, access, use, or disclosure of PHI which compromises the security or privacy of such information.
Parts 160 and 164. O. The Provider agrees, whether located exclusively within a nursing facility or servicing nursing home patients in the retail environment, to abide by WCSF rules and regulations particularly in respect to billing for chronic maintenance medication for thirty (30) day supplies. Providers servicing nursing home residents and who are contractually obligated to deliver weekly supplies of medications and whose software can not accommodate the 30 day billing requirement prior to medication dispensing should submit these nursing home resident claims by identifying these cardholders as being in “Long Term Care” (number “4” in the Patient Location field) contained in the Patient Segment thereby permitting the Program to reimburse one dispensing (1) fee.
Parts 160 and 164. C. The data elements or categories of data elements that may be requested are described in Appendix A, Section 6. Data requested may be disclosed only in compliance with federal law.
Parts 160 and 164. Unless the Secretary directs otherwise, Business Associate shall promptly notify Company of Business Associate’s receipt of such request, so that Company can assist in compliance with that request.
Parts 160 and 164. All other capitalized terms used in this BAA shall have the meanings set forth in HIPAA Requirements, unless this BAA indicates otherwise.
Parts 160 and 164. All references to sections in the Code of Federal Regulations refer to such sections as they may be amended, supplemented, or replaced from time to time.
Parts 160 and 164. The relationship of the Parties shall be governed by the terms and conditions of the Business Associate Agreement, attached hereto as Exhibit A and incorporated herein by this reference.
Parts 160 and 164. 3. The LTCAs may use and disclose Protected Health Information (PHI) only as required to satisfy its obligations herein, as permitted herein, or required by law, but shall not otherwise use or disclose any PHI. The LTCAs shall not, and shall ensure that its directors, officers, employees, contractors and agents do not use or disclose PHI received from ADvantage Provider in any manner that would constitute a violation of the HIPAA Privacy Standards if so used or disclosed by ADvantage Provider, except that the LTCAs may use PHI:
