Provider Refunds Of Claims Covered By Other Payments Sample Clauses

Provider Refunds Of Claims Covered By Other Payments. 5 1. If CONTRACTOR, through its own efforts, identifies Medi-Cal coverage, third party 6 settlement, primary or other insurance coverage for services reimbursed through the Agreement, 7 CONTRACTOR shall, within thirty (30) calendar days of such identification, unless disputed in 8 accordance with subparagraph G.2. below, reimburse the Intermediary an amount equal to the MSN 9 payment. If Medi-Cal coverage, third party settlement, primary or other insurance coverage is identified 10 due to efforts of Intermediary’s Third Party Recovery Services (Recovery Services) specified in 11 subparagraph G.4. below, CONTRACTOR shall, within thirty (30) calendar days of notice from 12 Recovery Services, unless disputed in accordance with subparagraph G.2. below, reimburse the 13 Intermediary an amount equal to the MSN payment. Third-party settlement payments may be paid 14 directly to COUNTY or Intermediary, as directed by ADMINISTRATOR. 15 2. Should CONTRACTOR wish to dispute the reimbursement of a MSN payment as a result 16 of the identification of Medi-Cal coverage, third party settlement, primary or other insurance coverage 17 either by CONTRACTOR or through Recovery Services, CONTRACTOR shall give written notice, 18 within thirty (30) calendar days of notice of information, to ADMINISTRATOR’s MSN Program 19 Administrator or designee (MSN Administrator) setting forth in specific terms the existence and nature 20 of any dispute or concern related to the information provided through Recovery Services or the 21 reimbursement due MSN. MSN Administrator shall have fifteen (15) business days following such 22 notice to obtain resolution of any issue(s) identified in this manner, provided, however, by mutual 23 consent this period of time may be extended. If MSN Administrator determines that the recovery 24 information is accurate and appropriate, CONTRACTOR shall, within thirty (30) calendar days of 25 receipt, reimburse an amount equal to the MSN payment. 26 3. For purposes of computing the amount of reimbursement due from CONTRACTOR, after 27 Final Settlement, the services provided an Enrollee shall be valued at the percentage of reimbursement 28 for the applicable contract period, less any co-payments or other fees. 29 4. COUNTY has contracted for Third Party Recovery Services (Recovery Services) for the 30 purpose of actively pursuing reimbursement of claims paid for MSN Enrollees later determined to be 31 eligible for Medi-Cal or third party, primary or other insuran...
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Provider Refunds Of Claims Covered By Other Payments. 13 1. As allowed in subparagraph II.B. of Exhibit A to the Agreement, if HOSPITALIf 14 CONTRACTOR, through its own efforts, identifies Medi-Cal coverage, any type of third- party Agreement, during the term of the Agreement, HOSPITAL shall notify CONTRACTOR shall, within thirty (30) calendar days of such identification, unless disputed in accordance with subparagraph G.2. 15 settlement, primary coverage or other insurance coverage for services reimbursed through the 16 18 Intermediary of such coverage and provide the corresponding claim information to 19 Intermediary, as directed by Intermediary. Intermediary shall retract the appropriate corresponding 20 Points from HOSPITAL prior to Final Settlement. an amount equal to the MSN payment. If Medi-Cal 21 coverage or, third- party settlement, primary or other insurance coverage is identified due to efforts of 22 ADMINISTRATOR’s contractedIntermediary’s Third- Party Recovery AgentServices (Recovery 23 Services) as specified in subparagraph G.54. below, HOSPITALCONTRACTOR shall, within thirty 24 (30) 25 G3 . below, reimburse the Intermediary an amount equal to the MSIMSN payment. Third-party 26 settlement payments may be paid directly to COUNTY or as specified in subparagraph G.5.
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Provider Refunds Of Claims Covered By Other Payments. 9 1. Medi-Cal Reimbursement and Third-Party Settlement 10 a. If HOSPITAL, through its own efforts, identifies and receives Medi-Cal reimbursement 11 or third-party settlement for services reimbursed through this Agreement, during the term of this 12 Agreement, HOSPITAL shall notify Intermediary of such reimbursement and provide the corresponding 13 claim information to Intermediary, as directed by Intermediary. Intermediary shall retract the 14 appropriate corresponding Points from HOSPITAL prior to Final Settlement. If Medi-Cal 15 reimbursement or third-party settlement is identified and received by HOSPITAL due to efforts of 16 Intermediary’s Third-Party Recovery Group (Recovery Group) as specified in subparagraph G.4. below, 17 HOSPITAL shall, within thirty (30) days of receipt unless disputed in accordance with subparagraph c. 18 below, reimburse the Recovery Group an amount equal to the MSI payment or the Medi-Cal or third- 19 party settlement payment, whichever is less. Third-party settlement payments may be paid directly to 20 COUNTY or to the Intermediary’s Third-Party Recovery Group specified in subparagraph G.4 below, 21 as directed by ADMINISTRATOR.. 22 b. If HOSPITAL, through its own efforts, identifies and receives Medi-Cal reimbursement 23 or third-party settlement for services reimbursed through any prior Agreement for MSI Hospital 24 Services, HOSPITAL shall, within thirty (30) days of receipt, reimburse the Intermediary an amount 25 equal to the MSI payment or the Medi-Cal or third-party settlement payment, whichever is less. Third- 26 party settlement payments may be paid directly to COUNTY or Intermediary. If Medi-Cal 27 reimbursement or third-party settlement is identified and received by HOSPITAL due to efforts of the 28 Recovery Group as specified in subparagraph G.4. below, HOSPITAL shall, within thirty (30) days of 29 receipt unless disputed in accordance with subparagraph c. below, reimburse an amount equal to the 30 MSI payment or the Medi-Cal or third-party settlement payment, whichever is less. Third-party 31 settlement payments may be paid directly to COUNTY, Intermediary, or to the Intermediary’s Third- 32 Party Recovery Group specified in subparagraph G.4 below, as directed by ADMINISTRATOR. 33 c. Should HOSPITAL wish to dispute the accuracy of the Recovery Group’s 34 identification of Medi-Cal reimbursement or third-party settlement, HOSPITAL shall give written 35 notice, within thirty (30) days of receipt of information fro...
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Provider Refunds Of Claims Covered By Other Payments. 13 1. As allowed in subparagraph II.B. of Exhibit A to the Agreement, if HOSPITAL, through its 14 own efforts, identifies Medi-Cal coverage, any type of third-party settlement, primary coverage or other 15 insurance for services reimbursed through the Agreement, during the term of the Agreement, 16 HOSPITAL shall notify Intermediary of such coverage and provide the corresponding claim information 17 to Intermediary, as directed by Intermediary. Intermediary shall retract the appropriate corresponding 18 Points from HOSPITAL prior to Final Settlement. If Medi-Cal coverage or third-party settlement is 19 identified due to efforts of ADMINISTRATOR’s contracted Third-Party Recovery Agent (Recovery 20 Services) as specified in subparagraph G.5. below, HOSPITAL shall, within thirty (30) days of notice 21 from Recovery Services, unless disputed in accordance with subparagraph G3. below, reimburse an 22 amount equal to the MSI payment. Third-party settlement payments may be paid directly to COUNTY 23 or as specified in subparagraph G.5. below, as directed by ADMINISTRATOR.
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Related to Provider Refunds Of Claims Covered By Other Payments

  • Payment of Claims A. If advance payment of all or a portion of the Grant funds is permitted by statute or regulation, and the State agrees to provide such advance payment, advance payment shall be made only upon submission of a proper claim setting out the intended purposes of those funds. After such funds have been expended, Grantee shall provide State with a reconciliation of those expenditures. Otherwise, all payments shall be made thirty five (35) days in arrears in conformance with State fiscal policies and procedures. As required by IC § 4-13-2-14.8, all payments will be by the direct deposit by electronic funds transfer to the financial institution designated by the Grantee in writing unless a specific waiver has been obtained from the Indiana Auditor of State B. Requests for payment will be processed only upon presentation of a Claim Voucher in the form designated by the State. Such Claim Vouchers must be submitted with the budget expenditure report detailing disbursements of state, local and/or private funds by project budget line items. C. The State may require evidence furnished by the Grantee that substantial progress has been made toward completion of the Project prior to making the first payment under this Grant. All payments are subject to the State's determination that the Grantee's performance to date conforms with the Project as approved, notwithstanding any other provision of this Grant Agreement. D. Claims shall be submitted to the State within 10 calendar days following the end of the month in which work on or for the Project was performed. The State has the discretion, and reserves the right, to NOT pay any claims submitted later than 35 calendar days following the end of the month in which the services were provided. All final claims and reports must be submitted to the State within 10 calendar days after the expiration or termination of this agreement. Payment for claims submitted after that time may, at the discretion of the State, be denied. Claims may be submitted on a monthly basis only. If Grant funds have been advanced and are unexpended at the time that the final claim is submitted, all such unexpended Grant funds must be returned to the State. E. Claims must be submitted with accompanying supportive documentation as designated by the State. Claims submitted without supportive documentation will be returned to the Grantee and not processed for payment. Failure to comply with the provisions of this Grant Agreement may result in the denial of a claim for payment.

  • Settlement of Claims The Company’s obligation to make the payments provided for in this Agreement and otherwise to perform its obligations hereunder shall not be affected by any circumstances, including, without limitation, any set-off, counterclaim, recoupment, defense or other right which the Company may have against the Executive or others.

  • Claims Payment The Reinsurer will be liable to the Company for its share of the benefits owed under the express contractual terms of the Reinsured Policies and as specified under the terms of this Agreement. The Reinsurer will not participate in any ex gratia payments made by the Company (i.e., payments the Company is not required to make under the Reinsured Policy terms.) The payment of death benefits by the Reinsurer will be in one lump sum regardless of the mode of settlement under the Reinsured Policy. Benefit payments from the Reinsurer will be due within 30 days of the claim satisfying the requirements established under this Agreement. The Reinsurer’s share of any interest payable under the terms of a Reinsured Policy or applicable law which is based on the death benefits paid by the Company, will be payable provided that the Reinsurer will not be liable for interest accruing on or after the date of the Company’s payment of benefits. The Reinsurer’s share will be based upon the same interest rate and days used by the Company to calculate their interest paid. The Reinsurer will make payment to the Company for each such claim. For Waiver of Premium claims, the Company will continue to pay premiums for reinsurance, except premiums for disability reinsurance. The Reinsurer will pay its proportionate share of the gross premium waived by the Company on the Reinsured Policy, including its share of the premiums for benefits that remain in effect during disability. I414849US-12 (11-01-2011) QT#04028US11 (COLI & BXXx) For claims on Accelerated Benefit riders reinsured under this Agreement, the benefit amount payable by the Reinsurer will be calculated by multiplying the total accelerated death benefit rider payout by the ratio of the reinsured Net Amount at Risk, as defined in Exhibit C -1, to the face amount of the Reinsured Policy.

  • Indemnification for Certain Claims The Party providing services hereunder, its affiliates and its parent company, shall be indemnified, defended and held harmless by the Party receiving services hereunder against any claim, loss or damage arising from the receiving company’s use of the services provided under this Agreement pertaining to (1) claims for libel, slander or invasion of privacy arising from the content of the receiving company’s own communications, or (2) any claim, loss or damage claimed by the End User of the Party receiving services arising from such company’s use or reliance on the providing company’s services, actions, duties, or obligations arising out of this Agreement.

  • Claim by Contractor After receipt of the Notice of Termination from the state, the Contractor shall submit any claim for additional costs not covered herein or elsewhere in the Contract within 60 days of the effective termination date, and not thereafter. Should the Contractor fail to submit a claim within the 60-day period, the State may, at its sole discretion, based on information available to it, determine what, if any, compensation is due the Contractor and pay the Contractor the determined amount.

  • No Entitlement or Claims for Compensation By accepting this Agreement, you hereby acknowledge and agree as follows:

  • Compensation Claims Section 1. When an injury is reported the reference number will be given to the employee and when requested, a copy of the injury report will be furnished to the employee within two (2) working days of such request. A copy of the injury report will also be furnished to the Local Union if requested by a Local Union official. The Employer agrees to cooperate and make a reasonable effort to provide the disposition of employee on-the-job injury claims within ten (10) business days. No employee will be disciplined or threatened with discipline or retaliated against as a result of filing an on-the-job injury report. The Employer or its designee shall not visit an injured worker at his/her their home. The Employer shall provide the Union Co-chair of the National Safety and Health Committee with current summaries of the essential functions of all positions covered by this Agreement. The Union shall have the right to challenge any such summary through the applicable grievance procedure. Any employee who is adversely affected by any such summary shall have the right to challenge such summary through the applicable grievance procedure. Any such decisions or settlements rendered through the grievance procedure, including but not limited to, at arbitration, shall be based solely upon, and applicable to, the facts present in that individual case and shall have no precedential effect beyond that case. This stipulation is limited to cases involving or referencing essential job functions. The Employer shall provide Worker’s Compensation protection for all employees even though not required by state law or the equivalent thereof if the injury arose out of or in the course of employment. An employee who is injured on the job, and is sent home, or to a hospital, or who must obtain medical attention, shall receive pay at the applicable hourly rate for the balance of his/her their regular shift on that day. Upon receiving an employee’s timely report of injury, the Employer shall not pressure an employee to continue to work, nor shall the Employer interfere with an employee seeking medical attention. When, because of such pressure, an employee spends time in a clinic after his or her their normal finish time, the time spent shall be the subject of a pay claim through the grievance procedure. An employee who has returned to regular duties after sustaining a compensable injury, and who is required by the Worker’s Compensation doctor to receive additional medical treatment during the employee’s regularly scheduled working hours, shall receive the employee’s regular hourly rate of pay for such time. The Employer agrees to provide any employee injured locally immediate transportation, at the time of injury, from the job to the nearest appropriate medical facility and return to the job, or to the employee’s home, if required. In such cases, no representative of the Employer shall be permitted to accompany the injured worker while he/she is they are receiving medical treatment and/or being examined by the medical provider, without the employee’s consent. In the event that any employee sustains an occupational illness or injury while on a run away from the home terminal, the Employer shall obtain medical treatment for the employee, if necessary, and, thereafter, will provide transportation by bus, train, plane or automobile to the employee’s home terminal, if and when directed by a doctor. An employee that has a change in his/her their medical duty status shall report that change to the Employer. In the event of a fatality, arising in the course of employment while away from the home terminal, the Employer shall return the deceased to the home of the deceased at the point of domicile.

  • Compensation for Damages 4.1 If the Principal has disqualified the Bidder from the tender process prior to the award according to Section 3, the Principal is entitled to demand and recover the damages equivalent Xxxxxxx Money Deposit/Bid Security. 4.2 If the Principal has terminated the contract according to Section 3, or if the Principal is entitled to terminate the contract according to section 3, the Principal shall be entitled to demand and recover from the Contractor liquidated damages equivalent to 5% of the contract value or the amount equivalent to Security Deposit/Performance Bank Guarantee, whichever is higher.

  • Tax Claims Notwithstanding any other provision of this Agreement, the control of any claim, assertion, event or proceeding in respect of Taxes of the Company (including, but not limited to, any such claim in respect of a breach of the representations and warranties in Section 3.22 hereof or any breach or violation of or failure to fully perform any covenant, agreement, undertaking or obligation in Article VI) shall be governed exclusively by Article VI hereof.

  • Product Liability Claims As soon as it becomes aware, each party will give the other prompt written notice of any defect or alleged defect in a Product, any injury alleged to have occurred as a result of the use or application of a Product, and any circumstances that may give rise to litigation or recall of a Product or regulatory action that may affect the sale or manufacture of a Product, specifying, to the extent the party has such information, the time, place and circumstances thereof and the names and addresses of the persons involved. Each party will also furnish promptly to the other copies of all papers received in respect of any claim, action or suit arising out of such alleged defect, injury or regulatory action.

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