Pre-Authorized Health Care Transactions Sample Clauses

Pre-Authorized Health Care Transactions. The following procedures shall be applicable to pre-authorized health care transactions: (1) If the Health Care Merchant agrees to accept a pre-authorized health care Transaction from a Cardholder for the purchase of services, the Cardholder shall complete and deliver to the Health Care Merchant an order form containing a written request for such services to be charged to the Cardholder’s account. The Order Form must at least specify the assignment of insurance benefits by the Cardholder to the Health Care Merchant, the Cardholder’s authorization for the Health Care Merchant to charge the Cardholder’s account for only that portion on the xxxx due subsequent to receipt of any applicable insurance payment by the Health Care Merchant, and the duration of time for which such Cardholder’s permission is granted, such period not to exceed one year. In the event that a pre-authorized health care Transaction is renewed, the Cardholder shall complete and deliver to the Health Care Merchant a subsequent order form continuation of such services to be charged to the Cardholder’s account; (2) A copy of the Order Form must be retained for the duration of the period for which it is in effect and provided in response to Bank’s request; (3) A Health Care Merchant must not complete an initial or subsequent pre-authorized health care Transaction after receiving a cancellation notice from the Cardholder, its Acquirer or a response that the card is not to be honored The Health Care Merchant shall type or print legibly on the “signature line” of the Sales Draft “Pre-Authorized Health Care”; (4) Upon receipt by the Health Care Merchant of the notice of adjudication from the Cardholder’s insurance company, the Health Care Merchant shall complete a Sales Draft and request authorization for the amount of the Cardholder’s portion of the xxxx. The sales draft must be submitted into interchange within 90 days of the date of services.
Sample 1
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