Prohibition on Billing Recipients for Covered Services Sample Clauses

Prohibition on Billing Recipients for Covered Services. The MCO, its providers and subcontractors shall not xxxx a member for services in the benefit package provided during the member’s enrollment period in the MCO, except as provided for in the 1915(c) waiver post-eligibility treatment of income and the purchase of enhanced services as allowed under this article, Section J., Department Policy for Member Use of Personal Resources. This provision pertains even if the: a. MCO becomes insolvent; b. Department does not pay the MCO for covered services provided to the member; c. Department or the MCO does not pay the provider that furnishes the services under a subcontractual referral or other arrangement; and, d. Payment for services furnished under a subcontract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the MCO provided the service directly.
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Prohibition on Billing Recipients for Covered Services. The Indian Health Care Provider (IHCP), its providers and subcontractors shall not xxxx a member for services in the benefit package provided during the member’s enrollment period in the MCO, except as provided for in the 1915(c) waiver post-eligibility treatment of income and the purchase of enhanced services as allowed under Article II, of this agreement. This provision pertains even if the: a. Indian Health Care Provider (IHCP) becomes insolvent; b. MCO or Department does not pay the Indian Health Care Provider (IHCP) for covered services provided to the member.
Sample 1
Prohibition on Billing Recipients for Covered Services. The PO, its providers and subcontractors shall not bill a member for services provided during the member’s enrollment period in PACE, except for the purchase of enhanced services as allowed under this article. Post-eligibility treatment of income and PACE premiums in 42 CFR §460.184 are not bills for services. This provision pertains even if the: a. PO becomes insolvent; b. Department does not pay the PO for covered services provided to the member; c. Department or the PO does not pay the provider that furnishes the services under a referral or other arrangement; and d. Payment for services furnished under a subcontract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the PO provided the service directly.
Sample 1
Prohibition on Billing Recipients for Covered Services. The PO, its providers and subcontractors shall not bill a member for services provided during the member’s enrollment period in PACE, except for the purchase of enhanced services as allowed under this article. Post-eligibility treatment of income and PACE premiums in 42 CFR §460.184 are not bills for services. This provision pertains even if the: PO becomes insolvent; Department does not pay the PO for covered services provided to the member; Department or the PO does not pay the provider that furnishes the services under a referral or other arrangement; and Payment for services furnished under a subcontract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the PO provided the service directly. In the event of the PO’s insolvency, the PO shall not bill members for debts of the PO or for services provided during the member’s period of PACE enrollment.
Sample 1
Prohibition on Billing Recipients for Covered Services. The IHCP, its providers and subcontractors shall not bill a member for services in the benefit package provided during the member’s enrollment period in the MCO, except for the purchase of enhanced services as allowed under Article II of this agreement. Post-eligibility treatment of income is not a bill for services. This provision pertains even if any of the following occur: IHCP becomes insolvent. MCO or Department does not pay the IHCP for covered services provided to the member. Department or the MCO does not pay the provider that furnishes the services under a referral or other arrangement. Payment for services furnished under a subcontract, referral, or other arrangement, to the extent that those payments are in excess of the amount that the member would owe if the MCO provided the service directly. In the event of the IHCP's insolvency, IHCP shall not bill members for debts of the IHCP or for services in the benefit package and provided during the member’s period of MCO enrollment.
Sample 1

Related to Prohibition on Billing Recipients for Covered Services

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  • Reliance on Third Party Service Providers Each Party may allow Reporting Financial Institutions to use third party service providers to fulfill the obligations imposed on such Reporting Financial Institutions by a Party, as contemplated in this Agreement, but these obligations shall remain the responsibility of the Reporting Financial Institutions.

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  • The Web Services E-Verify Employer Agent agrees to, consistent with applicable laws, regulations, and policies, commit sufficient personnel and resources to meet the requirements of this MOU.

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