Payments to Providers. Payments shall not be made on behalf of an enrollee to providers of health care services other than the contractor for the benefits covered in Article Four and rendered during the term of this contract.
Payments to Providers. Except as provided under federal regulation 42 CFR §§447.56(c)(2) and (c)(3), each MCO must reduce the payment it makes to a provider by the amount of a beneficiary's copayment obligation, regardless of whether the provider has collected the copayment or has waived the copayment. Where the MCO contracts a provider on a capitated basis, the beneficiary’s copayment obligation is taken into account in calculating capitated rates.
Payments to Providers. For purposes of this Agreement, timely payment shall mean payment by the earlier of (i) thirty (30) days after Medical Group's receipt of a clean claim, or (ii) such other period as is specified by applicable state or federal law or regulation (3) the time specified in the applicable Medical Group Subcontract. For purposes of this Section 3.13.1 and Section 3.13.2, a clean claim is one in which Medical Group has received the complete claim and all information necessary to determine liability for the claim. Medical Group shall provide, at PacifiCare's request, claims reports in a form to be mutually agreed upon by the parties.
Payments to Providers. Payments to Preferred Providers shall be made by UHS on behalf of the City in accordance with the terms of the agreements with those providers and, except to the extent the Health Service is subject to coordination of benefits and/or subrogation recovery, shall be billed to City in accordance with Exhibit D. Health Services subject to coordination of benefits and/or a subrogation recovery shall be billed to City in accordance with the Preferred Provider's Customary Charges after any copayments and/or deductibles have been applied. City acknowledges that there may be arrangements with providers or suppliers of pharmacy Health Services under which UHS or its affiliates may receive and retain payments from those providers or suppliers in return for services. UHS, as soon as administratively possible at the end of each Plan year, will provide City with an accounting of the amounts received from providers or suppliers of pharmacy Health Services. Non-Preferred Providers shall be paid by City according to the terms and conditions of the Plan. In the event that a dispute arises between City and any provider regarding payment of a claim, City shall promptly inform UHS of the dispute and UHS shall use reasonable efforts to facilitate resolution of the dispute.
Payments to Providers
