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. 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. 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. 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. Conditions........................................................................................................
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.
b. In the case that the Provider has failed to maintain their electronic enrollment record with accurate information including, but not limited to payment details and pay-to address, Medical Services reserves the right to suspend payment for services rendered until the Provider has updated their enrollment record.
c. Additional payment suspensions, such as those identified in 42 C.F.R. Part 455 may also apply.
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.
(b) If (i) any Senior Potential Default or Senior Default (other than a Senior Payment Default) occurs and is continuing unwaived and (ii) the Senior Lender gives written notice describing such Senior Potential Default or Senior Default (which notice shall state that such notice is a Blockage Notice) to the Borrower and the Subordinated Lender (a "Blockage -------- Notice"), then, unless and until (i) the Subordinated Lender or the Borrower ------ receives a written notice from the Senior Agent stating that such Senior Potential Default or Senior Default has been cured or waived or (ii) the Subordinated Lender or the Borrower receives a written notice from the Senior Agent terminating the Blockage Period commencing with such Blockage Notice, during such Blockage Period, 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. At the expiration or termination of such Blockage Period, the Borrower shall be obligated to, subject to Section 5(a), promptly pay (in accordance with the Subordinated Debt Agreements) to the Subordinated Lender Parties all sums not paid to the Subordinated Lender Parties during such Blockage Period as a result of this Section 5(b) (it being understood and agreed that any such payment in full by the Borrower shall cure any Subordinated Default which arose solely as a result of the nonpayment of any or all of such sums), so long as such payment does not trigger a Senior Potential Default or Senior Default.
(c) In the event that, notwithstanding the foregoing, any payment s...
Payment Suspension. (i) The Holder shall, at all times, be entitled to receive payments on account of the Subordinated Debt in accordance with the terms of this Note; provided, however, that, if and so long as a Senior Default (as defined below) has occurred and is continuing, and written notice thereof (the “Senior Default Notice”) has been delivered by the holders of the Senior Debt to the holders of the Subordinated Debt and the Company referencing the provisions of this paragraph 3 and demanding a suspension of payments during the period of such continuance in accordance with this subparagraph (b) (such period of time being referred to as the “Payment Suspension Period”), then, except as otherwise set forth below, the Company shall not make, and the holders of the Subordinated Debt shall not accept or receive from the Company, directly or indirectly, in cash or other property or by set-off or in any other manner (including, without limitation, from or by way of any collateral or redemption or sale), payment of all or any part of the Subordinated Debt unless and until the earlier of (A) the Senior Debt has been paid in full or (B) the Senior Default has been cured by the Company or waived by the holders of the Senior Debt or the holders of the outstanding principal amount of the Senior Debt have terminated the Payment Suspension Period, in each case in accordance with the terms of the relevant agreements governing such Senior Debt.
