Provider Refunds of Claims Reimbursed By Other Payments Sample Clauses

Provider Refunds of Claims Reimbursed By Other Payments. 22 1. If any Provider through its own efforts identifies Medi-Cal coverage, third party settlement, 23 primary or other insurance coverage for services reimbursed through the Agreement, such Provider(s) 24 shall, within thirty (30) calendar days of such identification, unless disputed in accordance with 25 subparagraph G.4. below, reimburse CONTRACTOR an amount equal to the MSN Payment. At 26 ADMINISTRATOR’s sole discretion, Skilled Nursing Facility providers may reimburse 27 CONTRACTOR an amount equal to the Medi-Cal coverage, third party settlement, primary or other 28 insurance coverage for services or MSN reimbursement amount, whichever is less. 29 2. If Medi-Cal coverage, third party settlement, primary or other insurance coverage is 30 identified due to efforts of COUNTY’s contracted Recovery Services (Recovery Services) specified in 31 Subparagraph G.6. below, the Provider shall, within thirty (30) days of notice from Recovery Services, 32 unless disputed in accordance with subparagraph G.4. below, reimburse COUNTY through 33 CONTRACTOR an amount equal to the MSN payment. Third-party settlement payments may be paid 34 directly to COUNTY or CONTRACTOR, as directed by ADMINISTRATOR. 35 3. If it is determined that a patient whose care was previously reimbursed with MSN funding 36 was eligible for third party reimbursement or primary other insurance, retroactively or otherwise, and 37 Provider could have sought such reimbursement and failed to do so, Provider shall reimburse COUNTY 1 through CONTRACTOR the amount of the MSN payment within thirty (30) calendar days notification 2 of said fact. 3 4. Should a Provider wish to dispute the reimbursement of MSN payment as a result of the 4 identification of Medi-Cal coverage, third party settlement, primary or other insurance coverage either 5 by the Provider or through Recovery Services, the Provider shall give written notice, within thirty (30) 6 calendar days of notice of information, to ADMINISTRATOR’s MSN Program Administrator, or 7 designee, (MSN Administrator) setting forth in specific terms the existence and nature of any dispute or 8 concern related to the information provided through Recovery Services or the reimbursement due 9 COUNTY. MSN Administrator shall have fifteen (15) business days following such notice to obtain 10 resolution of any issue(s) identified in this manner, provided, however, by mutual consent this period of 11 time may be extended. If MSN Administrator determines that the recov...
Sample 1
AutoNDA by SimpleDocs
Provider Refunds of Claims Reimbursed By Other Payments. 16 1. If any Provider receives Medi-Cal reimbursement for services reimbursed through this 17 Agreement, such provider(s) shall reimburse INTERMEDIARY an amount equal to the MSI Payment 18 or the Medi-Cal payment, whichever is less. 19 2. If any Provider receives reimbursement from a primary other insurance claim for services 20 reimbursed through this Agreement, such provider shall reimburse INTERMEDIARY an amount equal 21 to the MSI payment or the primary other insurance payment, whichever is less. 22 3. If any Provider receives reimbursement from a third-party settlement for services 23 reimbursed through this Agreement, such provider shall reimburse INTERMEDIARY an amount equal 24 to the MSI payment or the third-party settlement, whichever is less. Third-party settlement payments 25 may be directed by any Provider to be paid directly to COUNTY if the date(s) of service related to the 26 claim are such that the Provider has already written off the patient account. 27 4. If it is determined that a patient whose care was previously reimbursed with MSI funding 28 was eligible for third party reimbursement or primary other insurance, retroactively or otherwise, and 29 Provider could have sought such reimbursement and failed to do so, Provider shall reimburse 30 INTERMEDIARY the amount of the MSI payment within thirty (30) days notification of said fact. 31 5. ADMINISTRATOR may authorize INTERMEDIARY to subcontract with a Third-Party 32 Recovery Group (Recovery Group) for the purpose of actively pursuing reimbursement of claims paid 33 for MSI Eligibles later determined to be eligible for Medi-Cal or other primary other insurance.
Sample 1
Provider Refunds of Claims Reimbursed By Other Payments. 28 1. Refunds received from Contracting Hospitals shall be as specified in the MSI Hospital 29 Agreement and for the purposes of this Paragraph shall not be included in the definition of “Provider” as 30 follows, which shall mean All Providers except Contracting Hospitals. 31 2. If any Provider through its own efforts, identifies Medi-Cal coverage, third party 32 settlement, primary or other insurance coverage for services reimbursed through the Agreement, such 33 Provider(s) shall, within thirty (30) calendar days of such identification, unless disputed in accordance 34 with subparagraph G.54. below, reimburse INTERMEDIARYCONTRACTOR an amount equal to the 35 MSIMSN Payment. At ADMINISTRATOR’s sole discretion, Skilled Nursing Facility providers may 36 reimburse INTERMEDIARYCONTRACTOR an amount equal to the Medi-Cal coverage, third party 37 settlement, primary or other insurance coverage for services or MSIMSN reimbursement amount, 1 whichever is less.
Sample 1
Provider Refunds of Claims Reimbursed By Other Payments. Refunds received from Contracting Hospitals shall be as specified in the MSI Hospital 23 Agreement and for the purposes of this Paragraph shall not be included in the definition of “Provider”.
Sample 1

Related to Provider Refunds of Claims Reimbursed By Other Payments

  • Overpayments Contractor promptly shall refund to Purchaser the full amount of any erroneous payment or overpayment. Such refunds shall occur within thirty (30) calendar days of written notice to Contractor; Provided, however, that Purchaser shall have the right to elect to have either direct payments or written credit memos issued. If Contractor fails to make timely refunds of overpayment(s) (either directly or by credit memo), Contractor shall pay Purchaser interest at the rate of one percent (1%) per month on the amount overdue thirty (30) calendar days after notice to Contractor.

  • Refunds If Agent or a Lender determines, in its sole discretion, that it has received a refund of any Indemnified Taxes to which the Loan Parties have paid additional amounts pursuant to this Section 16, so long as no Default or Event of Default has occurred and is continuing, it shall pay over such refund to the Administrative Borrower on behalf of the Loan Parties (but only to the extent of payments made, or additional amounts paid, by the Loan Parties under this Section 16 with respect to Indemnified Taxes giving rise to such a refund), net of all out-of-pocket expenses of Agent or such Lender and without interest (other than any interest paid by the applicable Governmental Authority with respect to such a refund); provided, that the Loan Parties, upon the request of Agent or such Lender, agrees to repay the amount paid over to the Loan Parties (plus any penalties, interest or other charges, imposed by the applicable Governmental Authority, other than such penalties, interest or other charges imposed as a result of the willful misconduct or gross negligence of Agent or Lender hereunder as finally determined by a court of competent jurisdiction) to Agent or such Lender in the event Agent or such Lender is required to repay such refund to such Governmental Authority. Notwithstanding anything in this Agreement to the contrary, this Section 16 shall not be construed to require Agent or any Lender to make available its tax returns (or any other information which it deems confidential) to Loan Parties or any other Person or require Agent or any Lender to pay any amount to an indemnifying party pursuant to Section 16.4, the payment of which would place Agent or such Lender (or their Affiliates) in a less favorable net after-Tax position than such Person would have been in if the Tax subject to indemnification and giving rise to such refund had not been deducted, withheld or otherwise imposed and the indemnification payments or additional amounts with respect to such Tax had never been paid.

  • CP Costs Payments On each Settlement Date, Seller shall pay to Agent (for the benefit of the Conduits) an aggregate amount equal to all accrued and unpaid CP Costs in respect of the outstanding Capital of each of the Conduits for the related Settlement Period in accordance with Article II.

  • Other Payments You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).

  • Refunds and Overpayments A. At its sole discretion, the System Agency may (i) withhold all or part of any payments to Grantee to offset overpayments, unallowable or ineligible costs made to the Grantee, or if any required financial status report(s) is not submitted by the due date(s); or (ii) require Grantee to promptly refund or credit - within thirty (30) calendar days of written notice – to System Agency any funds erroneously paid by System Agency which are not expressly authorized under the Grant Agreement.

  • No Other Payments or Benefits The Executive acknowledges and agrees that upon the termination of his employment, no other benefits, compensation or remuneration of any kind is owed by the Company to the Executive other than as set forth in this Section 10 or as set forth in any Option Agreements.

  • Tax Refunds (a) Seller shall be entitled to the amount of any Income Tax refunds (or any Tax credits received in lieu thereof to the extent such credit in lieu thereof actually reduces Taxes for a Post-Closing Tax Period) that are actually received by Buyer, any Group Company, any of their respective Affiliates, or a consolidated, combined, unitary, or similar group of which any Group Company is a member after the Closing, in each case, for any Pre-Closing Tax Period ending on the Closing Date or the portion of any Straddle Period ending on the Closing Date (determined in accordance with Section 8.6.4), including any such Tax refunds resulting from any Transaction Tax Deductions, and net of any Taxes and reasonable out-of-pocket expenses incurred in connection with obtaining such Tax refunds (or credits in lieu thereof), in each case, to the extent such Tax refund (or credit in lieu thereof) is with respect to Taxes paid by a Group Company prior to the Closing Date or included in the final calculation of the Closing Statement (any such Income Tax refund or credit in lieu thereof, a “Tax Refund”); provided, however, that Seller shall not be entitled to any Tax Refund (x) required to be paid over by any Group Company (or any Affiliate thereof) to any Person under a provision of a Contract (other than this Agreement) to which such Person was a party prior to the Closing, (y) resulting from the payment of Income Taxes by Buyer or any of its Affiliates (including any Group Company) made after the Closing Date to the extent such Income Taxes were not included in the final calculation of the Closing Statement, and (z) resulting from a carryback of a Tax attribute from any period ending after the Closing Date. (b) Buyer shall promptly pay, or cause to be paid, over to Seller by wire transfer of immediately available funds any Tax Refunds that Seller is entitled to pursuant to this Section 8.6.1 within ten (10) Business Days of the actual receipt of the Tax Refund giving rise to Buyer’s obligation to make a payment pursuant to Section 8.6.1 with respect thereto (or, in the case of a credit in lieu of a refund, the Due Date for the filing of a Tax Return that reflects the actual reduction in Taxes resulting from such credit). (c) The Group Companies shall use commercially reasonable efforts to promptly obtain (or cause to be obtained) any reasonably available Tax Refunds with respect to any applicable Pre-Closing Period Income Tax Return by filing, or causing to file, any such Tax Returns as promptly as practicable after the Closing Date, in each case, as finally resolved pursuant to the provisions of Section 8.6.2; provided, however, that the Group Companies shall not be required to file IRS Form 4466 (or any comparable form for state or local Tax purposes). The Group Companies shall not elect to apply any applicable Tax Refund as a credit against Taxes payable for a taxable period (or portion thereof) beginning after the Closing Date. (d) For applicable Tax purposes, Buyer, Seller and each of their respective Affiliates shall treat all payments to Seller made pursuant to this Section 8.6.1 as an adjustment to purchase price to the maximum extent permitted by applicable Law.

  • Rebates, Credits and Refunds The HSP: (a) acknowledges that rebates, credits and refunds it anticipates receiving from the use of the Funding have been incorporated in its Budget; (b) agrees that it will advise the Funder if it receives any unanticipated rebates, credits and refunds from the use of the Funding, or from the use of funding received from either the Funder or the Ministry in years prior to this Agreement that was not recorded in the year of the related expenditure; and (c) agrees that all rebates, credits and refunds referred to in (b) will be considered Funding in the year that the rebates, credits and refunds are received, regardless of the year to which the rebates, credits and refunds relate.

  • Our Right to Make Payments and Recover Overpayments If payments which should have been made by us according to this provision have actually been made by another organization, we have the right to pay those organizations the amounts we decide are necessary to satisfy the rules of this provision. These amounts are considered benefits provided under this plan and we will not have to pay those amounts again. If we make payments for allowable expenses, which are more than the maximum amount needed to satisfy the conditions of this provision, we have the right to recover the excess amounts from: • the person to or for whom the payments were made; • any other insurers; and/or • any other organizations (as we decide). As the subscriber, you agree to pay back any excess amount paid, provide information and assistance, or do whatever is necessary to aid in the recovery of this excess amount. The amount of payments made includes the reasonable cash value of any

  • Sharing of Reimbursement Obligation Payments Whenever the Agent receives a payment from the Borrower on account of reimbursement obligations in respect of a Letter of Credit or Credit Support as to which the Agent has previously received for the account of the Letter of Credit Issuer thereof payment from a Lender, the Agent shall promptly pay to such Lender such Lender’s Pro Rata Share of such payment from the Borrower. Each such payment shall be made by the Agent on the next Settlement Date.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!