Payment to Providers. Alliant will assure that every Provider or facility that treats Members will seek reimbursement from Alliant and not from a Member or the Employer, except with respect to Co- Payment/Co-Insurance and other costs and expenses that are required to be paid by Member directly to Provider pursuant to the Certificate of Coverage.
Payment to Providers. CompCare is solely responsible for payment for MHSA Services provided to Members. In the event CompCare fails to pay CompCare Providers or non-CompCare Providers who furnish covered MHSA Services, Health Plans may, after written notice to CompCare and only after such CompCare Provider or non-CompCare Provider has exhausted its remedies under the appeals process set forth in CompCare’s agreement with such CompCare Provider and CompCare’s policies and procedures (in the case of non-CompCare Providers), make payments to such providers on behalf of CompCare; provided that if a provider attempts to collect from a Member, Health Plans may make payment without waiting for exhaustion of CompCare’s appeals process. In such case, Health Plans shall submit an itemized list of such payments to CompCare, and Health Plans shall deduct from CompCare’s future Capitation payment(s) (with the timing of such deductions and the element of the Capitation from which the deduction is made being at Health Plans’ sole discretion) an amount equal to such payments. CompCare hereby agrees to defend and hold harmless Health Plans from any claims for payment by CompCare Providers or non-CompCare Providers for Covered Services rendered to Members that are contemplated as the responsibility of CompCare under this Agreement.
Payment to Providers. 1.8.1 In Network Providers (Participating Providers).
A. The applicable In-Network Copayment, Deductible, and/or Coinsurance amounts;
B. Services that require Prior Authorization, which were not Prior Authorized;
C. Services that are not Medically Necessary; and
D. Services that are not Covered Services.
1.8.2 Out of Network Providers (Non-Participating Providers). Out-of-Network Rate (ONR). The ONR is the Allowed Amount for charges billed by Non-Participating Providers. The ONR is based on a percentage of what Medicare would pay the same Provider for the same service.
Payment to Providers. BJC shall be solely financially responsible for the compensation remitted to BJC Providers and Participating Providers for all Covered Services rendered to BJC Members whether provided in or outside of Plan's Service Areas and BJC's Service Sites. BJC shall and shall ensure that BJC Providers hold harmless and indemnify Plan and Payor against any claims for compensation by a BJC Provider. BJC shall hold harmless and indemnify Plan and Payor against any claims for compensation by a Participating Provider for Covered Services for which GHP has made payment to BJC out of the Claims Payment Account. BJC shall and shall assure that Providers provide Plan with Referral Authorizations and other information required for Plan to process and reconcile claims presented for payment by Providers within no later than 60 days from the date of service. Failure to submit claims within 90 days of the date of service or inpatient discharge may result in BJC and BJC Providers forfeiting the right to payment for such claims (member protection provisions in Section 5 below apply). The process by which BJC Providers and Participating Providers are paid shall comply with the terms and conditions set forth in this Agreement (including without limitation Section 3.4 and Section 3.1) and in EXHIBIT A-1, XXX X-0, X-0, XXX X-0.
Payment to Providers. Claims will be processed and adjudicated based on the terms and conditions contracted with each Participating Pharmacy by Xxxxx or Xxxxx’x designated network subcontractor.
Payment to Providers. Company shall be solely responsible for compensating Providers for all Health Services rendered to Members, and Company and Providers shall hold harmless and indemnify Plan and Payor against any claims for compensation by a Provider for Health Services. The method and amount of compensation to Provider shall be set forth in the Participation Agreement. 5 The information below marked by * and [] has been omitted pursuant to a request for confidential treatment. The omitted portion has been separately filed with the Commission.
Payment to Providers. The Participant, or their Representative/Nominee accepts ultimate responsibility for selecting who will provide other support services and advising 101 Plan Management who those providers are, their contact details and the Service Agreements or arrangements you have with them. 101 Plan Management encourages Participants to provide a copy of any agreements with other providers to 101 Plan Management to assist in the budgeting and management of their NDIS Plan. The Providers that 101 Plan Management will make payment to are detailed as outlined in a Service Support Report, Service Provider Category Budget, Consent to Exchange or as otherwise advised throughout the period of this Service Agreement. This is a list of the Providers you have asked us to pay to provide supports under your NDIS Plan which may include amounts that we will pay to these Providers under the NDIS Plan and in accordance with the NDIA Price Guide. 101 Plan Management is not responsible for any outstanding invoices that are unable to be processed and/or claimed whereby there is insufficient funds or funds are exhausted.
Payment to Providers. The Participant, or their Representative/Nominee, accepts ultimate responsibility for selecting who will provide other support services and advising 101 Plan Management who those providers are, their contact details and the Service Agreements or arrangements you have with them. 101 Plan Management encourages Participants to provide a copy of any agreements with other providers to 101 Plan Management to assist in the budgeting and management of their NDIS Plan. The Providers that 101 Plan Management will make payment to are detailed as outlined in a Service Support Report, Service Provider Category Budget, Consent to Exchange or as otherwise advised throughout the period of this Service Agreement. This is a list of the Providers you have asked us to pay to provide supports under your NDIS Plan which may include amounts that we will pay to these Providers under the NDIS Plan and in accordance with the NDIA Price Guide. The Participant, or their Representative/Nominee, consents to invoices being processed and claimed on their behalf upon receipt of compliant invoices. 101 Plan Management is not responsible for any outstanding invoices that are unable to be processed and/or claimed whereby there is insufficient funds or funds are exhausted.
Payment to Providers
