Common use of Reimbursement for Services Clause in Contracts

Reimbursement for Services. A. County will bill the Medi-Cal program on behalf of Provider for services rendered to Medi-Cal beneficiaries, which are within the scope of Medi-Cal covered services, using the provider number assigned by the Medi-Cal program to Provider. B. Payment will be authorized for valid claims for Specialty Mental Health Services if: (i) Services were pre-authorized by the Access Team, Utilization Review Committee of the County; however, Specialty Mental Health Services provided to a Beneficiary with an emergency psychiatric condition do not require preauthorization. (ii) Services were delivered by Provider and were within the range of pre-selected service codes allowed by scope of practice and contract agreement(s). (iii) Beneficiary was Medi-Cal eligible at the time services were provided. Following the initial authorization, it is the Provider’s responsibility to ensure that services are provided to eligible Beneficiaries. Medi-Cal Beneficiaries who become ineligible for Medi-Cal benefits during an authorization period may continue to receive services; however, the Provider must notify the Beneficiary and County that eligibility has changed. The County will determine the best treatment plan which may include authorizing continued services to ensure continuity of care and minimizing disruption of services or transition of the Beneficiary back to the County as appropriate. (iv) Payment shall be made to Provider only after Provider submits to County a fully itemized billing statement showing the unbundled services performed along with all documentation such as assessments, progress notes, treatment plans, etc. Provider shall submit the statement of services rendered to Xxxxx County Health and Human Services Agency, X.X. Xxx 000, Xxxxxxx, XX 00000, or by e-mail to GCHHSA Accounts Payable xxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx within 45 days after the end of the month. (v) On the day of discharge, Provider will make best efforts to discharge Beneficiary by 1:00 p.m. (vi) Reimbursement rate(s) shall be considered payment in full and are subject to Third Party Liability and Beneficiary share of cost. The County will only reimburse the difference between the County services rate(s) and the payment amount by the primary payer, minus the share of cost. The total reimbursement will conform with Provider’s fee schedule as described in Exhibit B, attached hereto and incorporated herein by reference, and as amended for each fiscal year to reflect any rate increases. (vii) Reimbursement to Provider for claims submitted timely, as defined in Section 6 of this Agreement, is in arrears within 45 days after receipt and verification of Provider’s invoice by County.

Reimbursement for Services. A. County will bill the Medi-Cal program on behalf of Provider for services rendered to Medi-Cal beneficiaries, which are within the scope of Medi-Cal covered services, using the provider number assigned by the Medi-Cal program to Provider. B. Payment will be authorized for valid claims for Specialty Mental Health Services if:Health (i) Services were pre-authorized by the Access Team, Utilization Review Committee of the County; however, Specialty Mental Health Services provided to a Beneficiary with an emergency psychiatric condition do not require preauthorization.Utilization (ii) Services were delivered by Provider and were within the range of pre-selected service codes allowed by scope of practice and contract agreement(s). (iii) Beneficiary was Medi-Cal eligible at the time services were provided. Following the initial authorization, it is the Provider’s responsibility to ensure that services are provided to eligible Beneficiaries. Medi-Cal Beneficiaries who become ineligible for Medi-Cal benefits during an authorization period may continue to receive services; however, the Provider must notify the Beneficiary and County that eligibility has changed. The County will determine the best treatment plan which may include authorizing continued services to ensure continuity of care and minimizing disruption of services or transition of the Beneficiary back to the County as appropriate. (iv) Payment shall be made to Provider only after Provider submits to County a fully itemized billing statement showing the unbundled services performed along with all documentation such as assessments, progress notes, treatment plans, etc. Provider shall submit the statement of services rendered to Xxxxx County Health and Human Services Agency, X.X. P. O. Xxx 000, Xxxxxxx, XX 00000, or by e-mail to GCHHSA Accounts Payable xxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx within 45 days after the end of the month. (v) On the day of discharge, Provider will make best efforts to discharge Beneficiary by 1:00 p.m. (vi) Reimbursement rate(s) shall be considered payment in full and are subject to Third Party Liability and Beneficiary share of cost. The County will only reimburse the difference between the County services rate(s) and the payment amount by the primary payer, minus the share of cost. The total reimbursement will conform with Provider’s fee schedule as described in Exhibit B, attached hereto and incorporated herein by reference, and as amended for each fiscal year to reflect any rate increases. (vii) Reimbursement to Provider for claims submitted timely, as defined in Section 6 of this Agreement, is in arrears within 45 days after receipt and verification of Provider’s invoice by County. (viii) The County will not pay for any session for which a Beneficiary fails

Reimbursement for Services. A. County will bill xxxx the Medi-Cal program on behalf of Provider for services rendered to Medi-Cal beneficiaries, which are within the scope of Medi-Cal covered services, using the provider number assigned by the Medi-Cal program to Provider. B. Payment will be authorized for valid claims for Specialty Mental Health Services if: (i) Services were pre-authorized by the Access Team, Utilization Review Committee of the County; however, Specialty Mental Health Services provided to a Beneficiary with an emergency psychiatric condition do not require preauthorization. (ii) Services were delivered by Provider and were within the range of pre-selected service codes allowed by scope of practice and contract agreement(s). (iii) Beneficiary was Medi-Cal eligible at the time services were provided. Following the initial authorization, it is the Provider’s responsibility to ensure that services are provided to eligible Beneficiaries. Medi-Cal Beneficiaries who become ineligible for Medi-Cal benefits during an authorization period may continue to receive services; however, the Provider must notify the Beneficiary and County that eligibility has changed. The County will determine the best treatment plan which may include authorizing continued services to ensure continuity of care and minimizing disruption of services or transition of the Beneficiary back to the County as appropriate. (iv) Payment shall be made to Provider only after Provider submits to County a fully itemized billing statement showing the unbundled services performed along with all documentation such as assessments, progress notes, treatment plans, etc. Provider shall submit the statement of services rendered to Xxxxx County Health and Human Services Agency, X.X. Xxx 000, Xxxxxxx, XX 00000, or by e-mail to GCHHSA Accounts Payable xxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx within 45 days after the end of the month. (v) On the day of discharge, Provider will make best efforts to discharge Beneficiary by 1:00 p.m. (vi) Reimbursement rate(s) shall be considered payment in full and are subject to Third Party Liability and Beneficiary share of cost. The County will only reimburse the difference between the County services rate(s) and the payment amount by the primary payer, minus the share of cost. The total reimbursement will conform with Provider’s fee schedule as described in Exhibit B, attached hereto and incorporated herein by reference, and as amended for each fiscal year to reflect any rate increases. (vii) Reimbursement to Provider for claims submitted timely, as defined in Section 6 of this Agreement, is in arrears within 45 days after receipt and verification of Provider’s invoice by County.

Reimbursement for Services. A. County will bill the Medi-Cal program on behalf of Provider for services rendered to Medi-Cal beneficiaries, which are within the scope of Medi-Cal covered services, using the provider number assigned by the Medi-Cal program to Provider. B. Payment will be authorized for valid claims for Specialty Mental Health Services if: (i) Services were pre-authorized by the Access Team, Utilization Review Committee of the County; however, Specialty Mental Health Services provided to a Beneficiary with an emergency psychiatric condition do not require preauthorization. (ii) Services were delivered by Provider and were within the range of pre-selected service codes allowed by scope of practice and contract agreement(s). (iii) Beneficiary was Medi-Cal eligible at the time services were provided. Following the initial authorization, it is the Provider’s responsibility to ensure that services are provided to eligible Beneficiaries. Medi-Cal Beneficiaries who become ineligible for Medi-Cal benefits during an authorization period may continue to receive services; however, the Provider must notify the Beneficiary and County that eligibility has changed. The County will determine the best treatment plan which may include authorizing continued services to ensure continuity of care and minimizing disruption of services or transition of the Beneficiary back to the County as appropriate. (iv) Payment shall be made to Provider only after Provider submits to County a fully itemized billing statement showing the unbundled services performed along with all documentation such as assessments, progress notes, treatment plans, etc. Provider shall submit the statement of services rendered to Xxxxx County Health and Human Services Agency, X.X. Xxx 000P. O. Box 611, XxxxxxxWillows, XX 00000CA 95988, or by e-mail to GCHHSA Accounts Payable xxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx within 45 days after the end of the month. (v) On the day of discharge, Provider will make best efforts to discharge Beneficiary by 1:00 p.m. (vi) Reimbursement rate(s) shall be considered payment in full and are subject to Third Party Liability and Beneficiary share of cost. The County will only reimburse the difference between the County services rate(s) and the payment amount by the primary payer, minus the share of cost. The total reimbursement will conform with Provider’s fee schedule as described in Exhibit B, attached hereto and incorporated herein by reference, and as amended for each fiscal year to reflect any rate increases. (vii) Reimbursement to Provider for claims submitted timely, as defined in Section 6 of this Agreement, is in arrears within 45 days after receipt and verification of Provider’s invoice by County. (viii) The County will not pay for any session for which a Beneficiary fails to show.

Reimbursement for Services. A. County will bill the Medi-Cal program on behalf of Provider for services rendered to Medi-Cal beneficiaries, which are within the scope of Medi-Cal covered services, using the provider number assigned by the Medi-Cal program to Provider. B. Payment will be authorized for valid claims for Specialty Mental Health Services if: (i) Services were pre-authorized by the Access Team, Utilization Review Committee of the County; however, Specialty Mental Health Services provided to a Beneficiary with an emergency psychiatric condition do not require preauthorization. (ii) Services were delivered by Provider and were within the range of pre-pre- selected service codes allowed by scope of practice and contract agreement(s). (iii) Beneficiary was Medi-Cal eligible at the time services were provided. Following the initial authorization, it is the Provider’s responsibility to ensure that services are provided to eligible Beneficiaries. Medi-Cal Beneficiaries who become ineligible for Medi-Cal benefits during an authorization period may continue to receive services; however, the Provider must notify the Beneficiary and County that eligibility has changed. The County will determine the best treatment plan which may include authorizing continued services to ensure continuity of care and minimizing disruption of services or transition of the Beneficiary back to the County as appropriate. (iv) Payment shall be made to Provider only after Provider submits to County a fully itemized billing statement showing the unbundled services performed along with all documentation such as assessments, progress notes, treatment plans, etc. Provider shall submit the statement of services rendered to Xxxxx County Health and Human Services Agency, X.X. Xxx 000P.O. Box 611, XxxxxxxWillows, XX 00000CA 95988, or by e-e- mail to GCHHSA Accounts Payable xxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx within 45 days after the end of the month.. Beneficiary by 1:00 p.m. (v) On the day of discharge, Provider will make best efforts to discharge Beneficiary by 1:00 p.m.discharge (vi) Reimbursement rate(s) shall be considered payment in full and are subject to Third Party Liability and Beneficiary share of cost. The County will only reimburse the difference between the County services rate(s) and the payment amount by the primary payer, minus the share of cost. The total reimbursement will conform with Provider’s fee schedule as described in Exhibit B, attached hereto and incorporated herein by reference, and as amended for each fiscal year to reflect any rate increases. (vii) Reimbursement to Provider for claims submitted timely, as defined in Section 6 of this Agreement, is in arrears within 45 days after receipt and verification of Provider’s invoice by County.

Reimbursement for Services. A. County will bill the Medi-Cal program on behalf of Provider for services rendered to Medi-Cal beneficiaries, which are within the scope of Medi-Cal covered services, using the provider number assigned by the Medi-Cal program to Provider. B. Payment will be authorized for valid claims for Specialty Mental Health Services if: (i) Services were pre-authorized by the Access Team, Utilization Review Committee of the County; however, Specialty Mental Health Services provided to a Beneficiary with an emergency psychiatric condition do not require preauthorization. (ii) Services were delivered by Provider and were within the range of pre-selected service codes allowed by scope of practice and contract agreement(s).. DocuSign Envelope ID: B9F4E1F2-7CF2-4608-AC80-F6EAD81E2502 (iii) Beneficiary was Medi-Cal eligible at the time services were provided. Following the initial authorization, it is the Provider’s responsibility to ensure that services are provided to eligible Beneficiaries. Medi-Cal Beneficiaries who become ineligible for Medi-Cal benefits during an authorization period may continue to receive services; however, the Provider must notify the Beneficiary and County that eligibility has changed. The County will determine the best treatment plan which may include authorizing continued services to ensure continuity of care and minimizing disruption of services or transition of the Beneficiary back to the County as appropriate. (iv) Payment shall be made to Provider only after Provider submits to County a fully itemized billing statement showing the unbundled services performed along with all documentation such as assessments, progress notes, treatment plans, etc. Provider shall submit the statement of services rendered to Xxxxx Glenn County Health and Human Services Agency, X.X. Xxx 000P.O. Box 611, XxxxxxxWillows, XX 00000CA 95988, or by e-mail to GCHHSA Accounts Payable xxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx within 45 days after the end of the month. (v) On the day of discharge, Provider will make best efforts to discharge Beneficiary by 1:00 p.m. (vi) Reimbursement rate(s) shall be considered payment in full and are subject to Third Party Liability and Beneficiary share of cost. The County will only reimburse the difference between the County services rate(s) and the payment amount by the primary payer, minus the share of cost. The total reimbursement will conform with Provider’s fee schedule as described in Exhibit B, attached hereto and incorporated herein by reference, and as amended for each fiscal year to reflect any rate increases. (vii) Reimbursement to Provider for claims submitted timely, as defined in Section 6 of this Agreement, is in arrears within 45 days after receipt and verification of Provider’s invoice by County.

Reimbursement for Services. A. County Provider will bill the xxxx Medi-Cal program on behalf of Provider for Mental Health services rendered to County Medi-Cal beneficiaries, which are within the scope of Medi-Cal covered services, using the provider number assigned by the Medi-Cal program to Provider. Provider will xxxx County for any residual balance not reimbursed by Medi-Cal or by any other third party. B. Payment will be authorized for valid claims for Specialty Mental Health Services if: (i) Services were pre-authorized by the Access Team, Utilization Review Committee of the County; however, Specialty Mental Health Services provided to a Beneficiary with an emergency psychiatric condition do not require preauthorization. (ii) Services were delivered by Provider and were within the range of pre-selected service codes allowed by scope of practice and contract agreement(s). (iii) Beneficiary was Medi-Cal eligible at the time services were provided. Following the initial authorization, it is the Provider’s responsibility to ensure that services are provided to eligible Beneficiaries. Medi-Cal Beneficiaries who become ineligible for Medi-Cal benefits during an authorization period may continue to receive services; however, the Provider must notify the Beneficiary and County that eligibility has changed. The County will determine the best treatment plan which may include authorizing continued services to ensure continuity of care and minimizing disruption of services or transition of the Beneficiary back to the County as appropriate. (iv) Payment shall be made to Provider only after Provider submits to County a fully itemized billing statement showing the unbundled services performed along with all documentation such as assessments, progress notes, treatment plans, etc. Provider shall submit the statement of services rendered to Xxxxx County Health and Human Services Agency, X.X. P. O. Xxx 000, Xxxxxxx, XX 00000, or by e-mail to GCHHSA Accounts Payable xxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx within 45 days after the end of the month. (v) On the day of discharge, Provider will make best efforts to discharge Beneficiary by 1:00 p.m. (vi) Reimbursement rate(s) shall be considered payment in full and are subject to Third Party Liability and Beneficiary share of cost. The County will only reimburse the difference between the County services rate(s) and the payment amount by the primary payer, minus the share of cost. The total reimbursement will conform with Provider’s fee schedule as described in Exhibit B, attached hereto and incorporated herein by reference, and as amended for each fiscal year to reflect any rate increases. (vii) Reimbursement to Provider for claims submitted timely, as defined in Section 6 of this Agreement, is in arrears within 45 days after receipt and verification of Provider’s invoice by County.

Reimbursement for Services. A. County will bill xxxx the Medi-Cal program on behalf of Provider for services rendered to Medi-Cal beneficiaries, which are within the scope of Medi-Cal covered services, using the provider number assigned by the Medi-Cal program to Provider. B. Payment will be authorized for valid claims for Specialty Mental Health Services if: (i) Services were pre-authorized by the Access Team, Utilization Review Committee of the County; however, Specialty Mental Health Services provided to a Beneficiary with an emergency psychiatric condition do not require preauthorization.preauthorization.‌ (ii) Services were delivered by Provider and were within the range of pre-selected service codes allowed by scope of practice and contract agreement(s). (iii) Beneficiary was Medi-Cal eligible at the time services were provided. Following the initial authorization, it is the Provider’s responsibility to ensure that services are provided to eligible Beneficiaries. Medi-Cal Beneficiaries who become ineligible for Medi-Cal benefits during an authorization period may continue to receive services; however, the Provider must notify the Beneficiary and County that eligibility has changed. The County will determine the best treatment plan which may include authorizing continued services to ensure continuity of care and minimizing disruption of services or transition of the Beneficiary back to the County as appropriate. (iv) Payment shall be made to Provider only after Provider submits to County a fully itemized billing statement showing the unbundled services performed along with all documentation such as assessments, progress notes, treatment plans, etc. Provider shall submit the statement of services rendered to Xxxxx County Health and Human Services Agency, X.X. P. O. Xxx 000, Xxxxxxx, XX 00000, or by e-mail to GCHHSA Accounts Payable xxxxxxxxxxxxxxxxxxxxx@xxxxxxxxxxxxx.xxx within 45 days after the end of the month. (v) On the day of discharge, Provider will make best efforts to discharge Beneficiary by 1:00 p.m. (vi) Reimbursement rate(s) shall be considered payment in full and are subject to Third Party Liability and Beneficiary share of cost. The County will only reimburse the difference between the County services rate(s) and the payment amount by the primary payer, minus the share of cost. The total reimbursement will conform with Provider’s fee schedule as described in Exhibit B, attached hereto and incorporated herein by reference, and as amended for each fiscal year to reflect any rate increases. (vii) Reimbursement to Provider for claims submitted timely, as defined in Section 6 of this Agreement, is in arrears within 45 days after receipt and verification of Provider’s invoice by County. (viii) The County will not pay for any session for which a Beneficiary