Reimbursement Terms. The Contract must provide a complete description of the payment method or payment amounts applicable to a provider. The MCO provider Contract or provider manual must explain to providers how to submit a clean claim including a complete listing of all required information, including claims coding and processing guidelines for the applicable provider type. The MCO provider must understand and agree that BMS is not liable or responsible for payment for covered services rendered pursuant to the MCO provider contract;
Reimbursement Terms. The total estimated project cost is included in the grant agreement. Subject to and in accordance with the terms and conditions of this Agreement, OPRD shall provide Grant Funds to Grantee for the project in an amount not to exceed the amount awarded in the grant agreement, whichever is less, for eligible costs of work completed. Grantee shall accept the Grant Funds and provide Match Funds for the Project as required by the grant.
Reimbursement Terms. Based on the estimated Project Cost of $5,338,800, and the Grantee’s Match participation rate of 85.95%, the reimbursement rate will be 14.05%. Upon successful completion of the Project and receipt of the final reimbursement request, the State will pay Grantee the remaining Grant Funds balance, or 14.05% of the total cost of the Project, whichever is less.
Reimbursement Terms. The Department shall reimburse the Contractor for Suitable Representative Functions under the following limitations.
a. The Department will reimburse:
1. Up to thirty-two (32) units per Calculated Budget appeal in connection with the Client’s initial Calculated Budget determination or Calculated Budget determination for purposes of annual redetermination, billable for an assigned initial referral commencing from the Contractor’s first contact with the Client. In case of documented attempts by the Contractor to contact the Client that resulted in initial referral closure due to inability to establish or maintain contact with the Client, the Department will pay one (1) unit. Following initial contact, appeal assistance will commence with the first fifteen (15) minute unit of billable activity. Appeal assistance services include, but are not limited to:
i. Helping the Client submit an Appeal Request Form to begin the process to appeal the Client’s Calculated Budget.
ii. Helping the Client prepare for Informal Review, Extended Informal Review, and Fair Hearings for Calculated Budget appeals. iii. Participating in an Informal Review, Extended Informal review, Fair Hearing, or one or more of these reviews or hearings, to advocate for the Client regarding the Client’s Calculated Budget.
Reimbursement Terms. If the Service Provider violates or breaches contract terms, the ESHP office must be notified and the Service Provider may be excluded from participating in future ESHP projects. In addition, reimbursement may be withheld from the Owner until contract requirements are satisfied.
Reimbursement Terms. If the Service Provider violates or breaches contract terms, the SHOP office must be notified and the Service Provider may be excluded from participating in future SHOP projects. In addition, reimbursement may be withheld from the Owner until contract requirements are satisfied.
Reimbursement Terms. A. For the following services, DMS shall reimburse ADH at a rate equal to the physicians’ fee schedule. The rates are subject to change according to revisions made to that schedule.
1. Family Planning Services
Reimbursement Terms. In case of cancellation: • From the day of registration up to 20 days prior to the start of the program, the total amount of the program will be refunded • Less than 20 days prior to the start of the program and up to 7 days before, the participant will have to pay half of the cost of the program. • From 6 days before the beginning of the program, the total amount will be charged. If the candidate decides to leave the program voluntarily, the cost of the program will be charged. In the event that the candidate conceals medical problems or conditions before registering to the program, or if a medical issue shall occur after registration and during the program, the organizer may decide to take measures regarding his participation in the various organized activities or dismissal from the program without reimbursement. Insofar as the candidate does not respect these program rules, the supervisory team will be obliged to warn, and/or punish and/or dismiss. In case of a dismissal, program fees will not be refunded. It is obvious that these are exceptional situations that we do not want and do not expect to occur.
Reimbursement Terms. The Municipality shall, within sixty (60) days of receipt of an itemized invoice pursuant to Section 7(c) or Section 7(e), reimburse the invoicing Party for actual eligible costs.
Reimbursement Terms. Amerigroup shall pay CCHH Provider and CCHH Provider shall accept as payment in full for CCHH Services provided to CCHH Participants the per member per month (PMPM) payment specified below in accordance with the terms of this Agreement.
