Payment Suspension. BMS may suspend portions of capitation payments from the MCO as a remedy for non- performance. Whenever BMS determines that the MCO has failed to provide one (1) or more of the Medically Necessary covered Contract services, BMS may suspend an estimated portion of the MCO’s capitation payment in subsequent months. Such suspension amount will be equal to the amount of money BMS expected the MCO to pay for Medically Necessary covered Contract services, plus any administrative costs involved. The MCO may not deny any Medically Necessary covered Contract services in order to receive adjusted payment levels. The MCO will be given written notice at least ten (10) business days prior to the suspension of any capitation payment in accordance with Article II, Section 6.8. When it suspends payments under this section, BMS must submit to the MCO a list of the enrollees for whom payment is being suspended, the nature of service(s) denied, and payments BMS must make to provide Medically Necessary covered Contract services. When all payments have been made by BMS for the MCO Medically Necessary covered Contract services, BMS will reconcile the estimated suspension against actual enrollee payments. BMS may suspend MCO payments in accordance with 42 CFR §455.23 in case of a credible allegation of fraud against the MCO.
Payment Suspension. The Department may suspend portions of capitation payments from the MCO as a remedy for non-performance. Whenever the Department determines that the MCO has failed to provide one (1)or more of the covered Contract services, the Department may suspend an estimated portion of the MCO’s capitation payment in subsequent months. Such suspension amount will be equal to the amount of money the Department expected the MCO to pay for covered Contract services, plus any administrative costs involved. The MCO may not deny any covered Contract services in order to receive adjusted payment levels. The MCO will be given written notice at least ten (10) business days prior to the suspension of any capitation payment in accordance with Article II, Section 6.8. When it suspends payments under this section, the Department must submit to the MCO a list of the enrollees for whom payment is being suspended, the nature of service(s) denied, and payments the Department must make to provide covered Contract services. When all payments have been made by the Department for the MCO covered Contract services, the Department will reconcile the estimated suspension against actual enrollee payments. The Department may suspend MCO payments in accordance with 42 CFR 455.23 in case of a credible allegation of fraud against the MCO.
Payment Suspension. Notwithstanding anything in this Note to the contrary, to the extent that the Company and the Holder dispute the amount of any indemnity payment alleged to be due from the Holder to the Company pursuant to and in accordance with the Agreement, then the Company may suspend payment under the Notes (other than any payment due by reason of the prior occurrence of an Event of Default) up to the net amount of such indemnity payments in dispute under the Agreement until such dispute is resolved and such suspension shall not be deemed an Event of Default.
Payment Suspension. The Department may suspend portions of capitation payments from the MCO as a remedy for non-performance. Whenever the Department determines that the MCO has failed to provide one or more of the Medically Necessary covered Contract services, the Department may suspend an estimated portion of the MCO’s capitation payment in subsequent months. Such suspension amount will be equal to the amount of money the Department expected the MCO to pay for Medically Necessary covered Contract services, plus any administrative costs involved. The MCO may not deny any Medically Necessary covered Contract services in order to receive adjusted payment levels. The MCO will be given at least ten working days written notice prior to the suspension of any capitation payment in accordance with Section 6.8. When it suspends payments under this section, the Department must submit to the MCO a list of the members for whom payment is being suspended, the nature of service(s) denied, and payments the Department must make to provide Medically Necessary covered Contract services. When all payments have been made by the Department for the MCO Medically Necessary covered Contract services, the Department will reconcile the estimated suspension against actual member payments. The Department may suspend MCO payments in accordance with 42 CFR 455.23 in case of a credible allegation of fraud against the MCO.
Payment Suspension. 30.1 Conditions........................................................................................................
Payment Suspension. Advertiser agrees to pay AOL for all advertising displayed in accordance with the agreed upon amounts and billing schedule shown on the Insertion Order.
Payment Suspension. The Department may suspend portions of capitation payments from the MCO as a remedy for non-performance. Whenever the Department determines that the MCO has failed to provide one
Payment Suspension a. In the case that the Provider has failed to maintain their enrollment record with accurate information including, but not limited to, payment details, contact information, address, NEMT reserves the right to suspend payment until the Provider has updated their enrollment record.
Payment Suspension a. In the case that the Provider’s eligibility status with Medical Services, Medicare, or another state’s Medicaid program is not active and in good standing, including retroactive determinations and periods of time where the Provider has not yet exhausted appeal rights, Medical Services reserves the right to suspend payment for services rendered. In the case where the Provider’s eligibility status is not returned to active and good standing, payment for services rendered during the determined period of ineligibility may be denied. Provider may not xxxx or have any recourse against a recipient or person acting on behalf of a recipient for services denied due to Provider ineligibility.
Payment Suspension. (a) If any default in the payment of any principal of or premium (if any) or interest on any Senior Debt when due and payable, whether at maturity, upon any redemption, by acceleration or otherwise (a "Senior Payment Default"), ---------------------- occurs and is continuing unwaived, no Borrower Party shall make any payment or distribution to any Subordinated Lender Party with respect to the Subordinated Debt or to acquire from any Subordinated Lender Party any Subordinated Debt for cash, securities or other property, except for the issuance of the PIK Notes as scheduled interest payments under, and in accordance with, the Subordinated Debt Agreements.
