Retroactive Denial Sample Clauses

Retroactive Denial. If ProCare denies reimbursement to Pharmacy, ProCare may only retroactively deny reimbursement for services subject to coordination of benefits with another carrier, Maryland Medical Assistance Program or the Medicare Program during the 18-month period after the date that ProCare paid the Pharmacy, and in all other circumstances, ProCare may only retroactively deny reimbursement during the six (6) month period after the date that ProCare paid the pharmacy. With the exception of overpayment claims under audit as described in Section 10 below, if a claim has been approved by ProCare through adjudication, ProCare shall not retroactively deny or modify reimbursement to Pharmacy for the approved Claims unless (i) the Claim was fraudulent; or (ii) Pharmacy has been reimbursed for the Claims previously; or (iii) the services reimbursed were not rendered by Pharmacy.
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Retroactive Denial. If MC-Rx denies reimbursement to Pharmacy, MC-Rx may only retroactively deny reimbursement for services subject to coordination of benefits with another carrier, Maryland Medical Assistance Program or the Medicare Program during the 18-month period after the date that MC-Rx paid the Pharmacy, and in all other circumstances, MC-Rx may only retroactively deny reimbursement during the six (6) month period after the date that MC-Rx paid the pharmacy. With the exception of overpayment claims under audit as described in Section 10 below, if a claim has been approved by MC-Rx through adjudication, MC-Rx shall not retroactively deny or modify reimbursement to Pharmacy for the approved Claims unless (i) the Claim was fraudulent; or (ii) Pharmacy has been reimbursed for the Claims previously; or (iii) the services reimbursed were not rendered by Pharmacy.

Related to Retroactive Denial

  • Retroactive Pay All employees shall receive full retroactive pay to May 21, 2021 for all hours worked and/or paid. Retroactive pay shall be paid to all employees within thirty (30) calendar days following the date of Union ratification of this Agreement. Retroactive pay will be issued to each employee in the bargaining unit on paycheques that are separate and apart from the employee's normal earnings.

  • Retroactivity Except as expressly noted, all the terms and conditions shall be effective from the date of receipt of written notice of ratification or release of award. Provisions which are expressly made retroactive shall apply to all employees in the bargaining unit on or after the date specified. Retroactivity will be paid within four full pay periods (approximately 8 weeks) of the date of ratification or arbitration award. Retroactivity will be on the basis of hours paid. Retroactive pay will be paid on a separate cheque where the existing payroll system allows. Where the existing payroll system does not allow for such separate cheque, the Home may pay retroactivity as part of the regular pay. In such circumstances, the Home undertakes that the rate of income tax on the retroactivity will not change unless the retroactive pay changes the employee’s annual tax bracket. The Home will contact former employees at their last known address on record with the home, with a copy to the bargaining unit, within 30 days of the date of ratification or arbitration award to advise them of their entitlement to retroactivity. Such employees will have a period of sixty (60) days from the date of the notice to claim such retroactivity and, if they fail to make a claim within the sixty (60) day period, their claim will be deemed to be abandoned.

  • Retroactive Effect If patient intends this agreement to cover services rendered before the date it is signed (for example, emergency treatment), patient should initial here. . Effective as of the date of first professional services. If any provision of this Arbitration Agreement is held invalid or unenforceable, the remaining provisions shall remain in full force and shall not be affected by the invalidity of any other provision. I understand that I have the right to receive a copy of this Arbitration Agreement. By my signature below, I acknowledge that I have received a copy. NOTICE: BY SIGNING THIS CONTRACT, YOU ARE AGREEING TO HAVE ANY ISSUE OF MEDICAL MALPRACTICE DECIDED BY NEUTRAL ARBITRATION, AND YOU ARE GIVING UP YOUR RIGHT TO A JURY OR COURT TRIAL. SEE ARTICLE 1 OF THIS CONTRACT. (Date) PATIENT SIGNATURE X (Or Patient Representative) (Indicate relationship if signing for patient) (Date) OFFICE SIGNATURE X . ALSO SIGN THE INFORMED CONSENT ON REVERSE SIDE ACUPUNCTURE INFORMED CONSENT TO TREAT I hereby request and consent to the performance of acupuncture treatments and other procedures within the scope of the practice of acupuncture on me (or on the patient named below, for whom I am legally responsible) by the acupuncturist indicated below and/or other licensed acupuncturists who now or in the future treat me while employed by, working or associated with or serving as back-up for the acupuncturist named below, including those working at the clinic or office listed below or any other office or clinic, whether signatories to this form or not. I understand that methods of treatment may include, but are not limited to, acupuncture, moxibustion, cupping, electrical stimulation, Tui-Na (Chinese massage), Chinese herbal medicine, and nutritional counseling. I understand that the herbs may need to be prepared and the teas consumed according to the instructions provided orally and in writing. The herbs may have an unpleasant smell or taste. I will immediately notify a member of the clinical staff of any unanticipated or unpleasant effects associated with the consumption of the herbs. I have been informed that acupuncture is a generally safe method of treatment, but that it may have some side effects, including bruising, numbness or tingling near the needling sites that may last a few days, and dizziness or fainting. Xxxxx and/or scarring are a potential risk of moxibustion and cupping, or when treatment involves the use of heat lamps. Bruising is a common side effect of cupping. Unusual risks of acupuncture include spontaneous miscarriage, nerve damage and organ puncture, including lung puncture (pneumothorax). Infection is another possible risk, although the clinic uses sterile disposable needles and maintains a clean and safe environment. I understand that while this document describes the major risks of treatment, other side effects and risks may occur. The herbs and nutritional supplements (which are from plant, animal and mineral sources) that have been recommended are traditionally considered safe in the practice of Chinese Medicine, although some may be toxic in large doses. I understand that some herbs may be inappropriate during pregnancy. Some possible side effects of taking herbs are nausea, gas, stomachache, vomiting, headache, diarrhea, rashes, hives, and tingling of the tongue. I will notify a clinical staff member who is caring for me if I am or become pregnant. While I do not expect the clinical staff to be able to anticipate and explain all possible risks and complications of treatment, I wish to rely on the clinical staff to exercise judgment during the course of treatment which the clinical staff thinks at the time, based upon the facts then known, is in my best interest. I understand that results are not guaranteed. I understand the clinical and administrative staff may review my patient records and lab reports, but all my records will be kept confidential and will not be released without my written consent. By voluntarily signing below, I show that I have read, or have had read to me, the above consent to treatment, have been told about the risks and benefits of acupuncture and other procedures, and have had an opportunity to ask questions. I intend this consent form to cover the entire course of treatment for my present condition and for any future condition(s) for which I seek treatment. ACUPUNCTURIST NAME: (Date) PATIENT SIGNATURE X (Or Patient Representative) (Indicate relationship if signing for patient)

  • Retroactive Financing 5. Withdrawals from the Loan Account may be made for reimbursement of eligible expenditures incurred under the Project before the Effective Date, but not earlier than 12 months before the date of this Loan Agreement in connection with items to be retroactively financed, subject to a maximum amount equivalent to 20% of the Loan amount. Schedule 3 Condition for Withdrawals from Loan Account

  • Retroactive Pay for Terminated Employees An employee who has retired or severed his/her employment between the termination date of this Agreement and the effective date of the new Agreement shall receive the full retroactivity of any increase in wages, salaries or other benefits.

  • Overtime-Eligible Employees Rest Periods The Employer and the Union agree to rest periods that vary from and supersede the rest periods required by WAC 000-000-000. Employees will be allowed rest periods of fifteen

  • Overtime-Eligible Rest Periods ‌ The Employer and the Union agree to rest periods that vary from and supersede the rest periods required by WAC 000-000-000. Employees will be allowed rest periods of fifteen (15) minutes for each one-half (1/2) shift of four (4) or more hours worked at or near the middle of each one-half (1/2) shift of four (4) or more hours. Rest periods do not require relief from duty. Rest periods may not be used for late arrival or early departure from work and rest and meal periods will not be combined.

  • Shift Differential Compensation Any employee in the bargaining unit whose assigned work shift commences (for unit-1) prior to 5:30 a.m. or whose work shift ends after 5:30 p.m., or (for unit-2 members) commences after 2:00 p.m. shall be paid a shift differential premium of five (5%) percent above the regular rate of pay for all hours worked.

  • Salary Determination 12.5.1 A unit member shall receive a salary not less than the minimum salary nor more than the maximum salary (Articles 12.3 and 12.4) for the rank to which appointed, except as provided in Articles 4.15, 5.6, 10.6.1 or Article 10.6.1.1. The effective dates for salaries shall be the appropriate dates specified in Article 12.2.2.

  • Overtime-Eligible Employees Unpaid Meal Periods The Employer and the Union agree to unpaid meal periods that vary from and supersede the unpaid meal period requirements required by WAC 000-000-000. Unpaid meal periods for employees working more than five (5) consecutive hours, if entitled, will be a minimum of thirty (30) minutes and will be scheduled as close to the middle of the work shift as possible, taking into account the Employer’s work requirements and the employee’s wishes. Employees working three (3) or more hours longer than a normal workday will be allowed an additional thirty (30) minute unpaid meal period. When an employee’s unpaid meal period is interrupted by work duties, the employee will be allowed to resume their unpaid meal period following the interruption, if possible, to complete the unpaid meal period. In the event an employee is unable to complete the unpaid meal period due to operational necessity, the employee will be entitled to compensation, which will be computed based on the actual number of minutes worked within the unpaid meal period. Meal periods may not be used for late arrival or early departure from work and meal and rest periods will not be combined.

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