Payment for Covered Services. Company shall make payment of claims for Covered Services directly to Participating Providers. In the case of Non-Participating Providers, the Covered Person is responsible for payment to the Provider, and payment of claims shall be made by Company directly to the Covered Person.
Payment for Covered Services. Covered Services shall be paid in accordance with the rates described below or in a separate relevant amendment to the Agreement.
Payment for Covered Services. The final decision as to whether any care should be received is between the Insured and the Provider. If SHL denies a request by an Insured and/or Provider for Prior Authorization of a service, the Insured or his Authorized Representative may appeal the denial to the Grievance Review Committee (see the Appeals Procedures Section).
Payment for Covered Services. In accordance with the terms and conditions hereof, Payor shall pay Provider for Covered Services provided to a Member by Provider. Payment shall be the lesser of: (a) Provider's Customary Charge, less any applicable Member Expenses; or (b) the Fee Maximum for such MHSA Services, less any applicable Member Expenses. Subject to the terms and conditions herein, the obligation for payment for Covered Services provided to a Member, less any applicable Member Expenses, is solely that of Payor. Additionally, UBH may arrange for claims processing services. When UBH is the Payor, UBH shall make obligated claim payments to Provider within 45 days (and shall use best efforts to encourage a third-party Payor to make payments within 45 days), or as otherwise required by law, of the date Payor receives all information necessary to process and pay a clean claim, except for claims for which there is coordination of benefits, Member Expense adjustments, disputes about coverage, systems failure or other such causes. In the event a Member's Benefit Plan provides for a Member Expense whether stated as a flat fee or a percentage, the amount of the Member Expense shall be calculated in accordance with the Member's Benefit Plan or as determined by the Payor. The amount calculated pursuant to the preceding sentence shall be deducted from the amount Provider is to be paid for the Covered Services pursuant to this Agreement.
Payment for Covered Services. The compensation set forth in the Service and Rate Schedule (Medicaid Products) shall only apply to services that Provider renders to Members covered under the Medicaid Products set forth therein. Provider acknowledges and agrees that if an Affiliate of Company is the Payer for a particular Medicaid Product, such Affiliate's duties, obligations, and liabilities under the Agreement shall be strictly limited to the services Provider renders to Members covered under that Medicaid Product.
Payment for Covered Services. QualCare’s Network fee schedule is attached hereto as Exhibit A and incorporated herein by this reference. Participating Provider agrees to xxxx the applicable Payor the usual and customary charges that such Participating Provider bills other commercial third party payors and agrees to accept from the applicable Payor as payment in full for Covered Services rendered to Members the lesser of eighty percent (80%) of such Participating Provider’s usual and customary billed charges or the fee listed on QualCare’s Network fee schedule, less any applicable Co-Payments, Co-Insurance and Deductibles and less any amounts payable by another third party payor under the Coordination of Benefits provisions. Overpayments may be recovered by QualCare or the Payor, as applicable, in accordance with applicable federal and state laws, rules, and regulations, as well as with QualCare’s and/or the Payor’s policies and procedures, as applicable and as may be amended from time to time.
Payment for Covered Services. Client, following the receipt of a Clean Claim, will pay Group, as full compensation the Contract Rate. Client shall pay Group in accordance with the following:
Payment for Covered Services. Client, following the receipt of a Clean Claim, will pay Participating Professional, as full compensation the Contract Rate. Client shall pay or Participating Professional in accordance with the following:
Payment for Covered Services. X. Xxxx of Participating Dentists Who are PPO Dentists. All fees paid or otherwise discharged by Delta Dental to Participating Dentists who are PPO Dentists for Services under this PPO program, provided to Enrollees under this Contract shall be the PPO Allowed Amount, except as constrained by Article VI, Paragraph D. A Participating Dentist who is a PPO Dentist shall accept the PPO Allowed Amount as defined in Article I whether indicated to be paid by Delta Dental or Delta Dental and the Enrollee, as provided in Article VI, Paragraph D, as the total amount payable for the Services provided and shall not charge or accept an additional amount for such Services to or from either Enrollee or Delta Dental.
Payment for Covered Services. Client, following the receipt of a Clean Claim, will pay Ancillary Provider, as full compensation the Contract Rate. Client shall pay Ancillary Provider in accordance with the following:
