Post-Service Claims for Reimbursement or Payment Sample Clauses

Post-Service Claims for Reimbursement or Payment. An initial decision on a Claim for reimbursement or payment of health care expenses paid or owed by the Member for services or benefits obtained from a non-WHP provider will be made within thirty (30) days after the Claim is received unless this time is extended. If WHP is unable to make a decision within the initial thirty (30) day period, WHP will notify the Member in writing before the end of the thirty (30) days of the circumstances requiring the extension and date by which WHP expects to make a decision, that will be no later than an additional fifteen (15) days. If the reason for the extension is the failure of the Member to submit necessary information, the Member will be notified as to what information is needed, in which case the Member will have forty-five (45) days within which to submit the necessary information.
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Related to Post-Service Claims for Reimbursement or Payment

  • Post Service Claims In the case of a Post-Service Claim, CareFirst BlueChoice shall notify the Member of the CareFirst BlueChoice’s Adverse Benefit Determination within a reasonable period of time, but not later than 30 days after receipt of the claim. This period may be extended one time by CareFirst BlueChoice for up to 15 days, provided that CareFirst BlueChoice both determines that such an extension is necessary due to matters beyond the control of CareFirst BlueChoice and notifies the Member, prior to the expiration of the initial 30-day period, of the circumstances requiring the extension of time and the date by which CareFirst BlueChoice expects to render a decision. If such an extension is necessary due to a failure of the Member to submit the information necessary to decide the claim, the notice of extension shall specifically describe the required information, and the Member shall be afforded at least 45 days from receipt of the notice within which to provide the specified information.

  • Insurance Claims The Supplier shall promptly notify to insurers any matter arising from, or in relation to, the Goods and/or Services and/or this Framework Agreement for which it may be entitled to claim under any of the Insurances. In the event that the Authority receives a claim relating to or arising out of the Goods and/or Services or this Framework Agreement, the Supplier shall co-operate with the Authority and assist it in dealing with such claims including without limitation providing information and documentation in a timely manner. Except where the Authority is the claimant party, the Supplier shall give the Authority notice within twenty (20) Working Days after any insurance claim in excess of £30,000 relating to or arising out of the provision of the Goods and/or Services or this Framework Agreement on any of the Insurances or which, but for the application of the applicable policy excess, would be made on any of the Insurances and (if required by the Authority) full details of the incident giving rise to the claim. Where any Insurance requires payment of a premium, the Supplier shall be liable for and shall promptly pay such premium. Where any Insurance is subject to an excess or deductible below which the indemnity from insurers is excluded, the Supplier shall be liable for such excess or deductible. The Supplier shall not be entitled to recover from the Authority any sum paid by way of excess or deductible under the Insurances whether under the terms of this Framework Agreement or otherwise.  ANNEX 1: REQUIRED INSURANCES PART A: THIRD PARTY PUBLIC & PRODUCTS LIABILITY INSURANCE INSURED The Supplier INTEREST To indemnify the Insured in respect of all sums which the Insured shall become legally liable to pay as damages, including claimant's costs and expenses, in respect of accidental: death or bodily injury to or sickness, illness or disease contracted by any person; loss of or damage to property; happening during the period of insurance (as specified in Paragraph 5 of this Annex 1 to this Schedule 14) and arising out of or in connection with the provision of the Goods and/or Services and in connection with this Framework Agreement. LIMIT OF INDEMNITY Not less than £10,000,000 in respect of any one occurrence, the number of occurrences being unlimited, but £10,000,000 in any one occurrence and in the aggregate per annum in respect of products and pollution liability. TERRITORIAL LIMITS United Kingdom

  • Applications for Payment 9.3.1 At least ten days before the date for each progress payment established in the State- Contractor Agreement, the Contractor shall submit to the Architect an itemized Application for Payment, notarized if required, supported by such data substantiating the Contractor's right to payment as the State or the Architect may require. The application for payment must, at a minimum, reflect retainage and the required waivers of lien and any other support documentation enumerated elsewhere in the Contract Documents.

  • Payment of Stipulated Penalties EPA may send Purchaser a demand for stipulated penalties. The demand will include a description of the noncompliance and will specify the amount of the stipulated penalties owed. Purchaser may initiate dispute resolution under Section XIII regarding the demand. Purchaser shall pay the amount demanded or, if Purchaser initiates dispute resolution, the uncontested portion of the amount demanded, within 30 days after receipt of the demand. Purchaser shall pay the contested portion of the penalties determined to be owed, if any, within 30 days after the resolution of the dispute. Each payment for: (a) the uncontested penalty demand or uncontested portion, if late, and; (b) the contested portion of the penalty demand determined to be owed, if any, must include an additional amount for Interest accrued from the date of receipt of the demand through the date of payment. Purchaser shall make payment at xxxxx://xxx.xxx.xxx using the link for “EPA Miscellaneous Payments Cincinnati Finance Center,” including a reference to the CERCLA docket number and Site/Spill ID number listed in ¶ 92, and the purpose of the payment. Purchaser shall send a notice of this payment to DOJ and EPA. The payment of stipulated penalties and Interest, if any, does not alter any obligation by Purchaser under this Settlement. Nothing in this Settlement limits the authority of the United States: (a) to seek any remedy otherwise provided by law for Purchaser’s failure to pay stipulated penalties or interest; or (b) to seek any other remedies or sanctions available by virtue of Purchaser’s noncompliance with this Settlement or of the statutes and regulations upon which it is based including penalties under section 106(b) of CERCLA provided, however, that the United States may not seek civil penalties under section 106(b) for any noncompliance for which a stipulated penalty is provided herein, except in the case of a willful noncompliance with this Settlement or in the event that EPA assumes performance of a portion or all of the Work pursuant to ¶ 30 (Work Takeover). Notwithstanding any other provision of this Section, the United States may, in its unreviewable discretion, waive any portion of stipulated penalties that have accrued under this Settlement.

  • Payment of Overpayment If at any time the Province provides Funds in excess of the amount to which the Recipient is entitled under the Agreement, the Province may:

  • Basis for Payment Payment(s) to Consultant for services performed under this Contract shall be made as follows and shall [not] include payment for reimbursable expenses:

  • Retiree Benefits – Process for Payment Any bargaining unit nurse who retires and wishes to participate in the benefit plans as outlined in article 17.01(h) will provide advance payment of the benefits either through post-dated cheques provided on a yearly basis or through a preauthorized withdrawal process. It is understood that any transaction would be dated the first of each and every month. The Employer will notify the Union of the benefit costs to retired nurses in January of each year, and each time the benefit costs are renegotiated by the Employer.

  • Claims Administration An employee will be required to comply with any and all rules and regulations and/or limitations established by the carrier or applicable third party administrator and contained in the policy, and employees and their dependents shall look solely to such carrier or third party administration for the adjudication of the payment of any and all benefits claims.

  • Payment Disputes We will not exercise Our rights under Section 6.3 (Overdue Charges) or 6.4 (Suspension of Service and Acceleration) above if You are disputing the applicable charges reasonably and in good faith and are cooperating diligently to resolve the dispute.

  • Compensation for Reimbursable Expenses 11.8.1 Reimbursable Expenses are in addition to compensation for Basic, Supplemental, and Additional Services and include expenses incurred by the Architect and the Architect’s consultants directly related to the Project, as follows:

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