Common use of Return of Overpayments Clause in Contracts

Return of Overpayments. Under the BlueCard Program, recoveries from a Host Blue or its participating healthcare providers can arise in several ways, including, but not limited to, anti-fraud and abuse recoveries, healthcare provider/hospital audits, credit balance audits, utilization review refunds, and unsolicited refunds. In some cases, the Host Blue will engage a third party to assist in identification or collection of recovery amounts. The fees of such a third party may be netted against the recovery. Recovery amounts determined in this way will be applied in accordance with applicable Inter-Plan Programs policies, which generally require correction on a claim-by-claim or prospective basis.

Appears in 9 contracts

Samples: Sales Agreement, Sales Agreement, Sales Agreement

AutoNDA by SimpleDocs

Return of Overpayments. Under the BlueCard ProgramBlueCard, recoveries from a Host Blue or its from participating healthcare providers of a Host Blue can arise in several ways, including, including but not limited to, to anti-fraud and abuse recoveriesaudits, healthcare provider/hospital audits, credit balance audits, utilization review refunds, and unsolicited refunds. In some cases, the Host Blue will engage a third party parties to assist in identification discovery or collection of recovery amounts. The fees of such a third party may be are netted against the recovery. Recovery amounts determined in this way amounts, net of fees, if any, will be applied in accordance with applicable Inter-Plan Programs policiesBlueCard Policies, which generally require correction on a claim-by-claim or prospective basis.

Appears in 2 contracts

Samples: Group Health Service Contract, Group Health Service Contract

Return of Overpayments. Under the BlueCard ProgramBlueCard, recoveries from a Host Blue or its from participating healthcare providers of a Host Blue can arise in several ways, including, but not limited to, anti-fraud and abuse recoveriesaudits, healthcare provider/hospital audits, credit balance audits, utilization review refunds, and unsolicited refunds. In some cases, the Host Blue will engage a third party parties to assist in identification discovery or collection of recovery amounts. The fees of such a third party may be are netted against the recovery. Recovery amounts determined in this way amounts, net of fees, if any, will be applied in accordance with applicable Inter-Plan Programs policiesBlueCard Policies, which generally require correction on a claim-by-claim or prospective basis.

Appears in 2 contracts

Samples: Claims Administration and Cost Management Services Agreement, Claims Administration and Cost Management Services Agreement

Return of Overpayments. Under the BlueCard ProgramBlueCard, recoveries from a Host Blue or its from participating healthcare providers Providers of a Host Blue can arise in several ways, including, but not limited to, anti-fraud and abuse recoveriesaudits, healthcare providerProvider/hospital audits, credit balance audits, utilization review refunds, and unsolicited refunds. In some cases, the Host Blue will engage a third party parties to assist in identification discovery or collection of recovery amounts. The fees of such a third party may be are netted against the recovery. Recovery amounts determined in this way amounts, net of fees, if any, will be applied in accordance with applicable Inter-Plan Programs policiesBlueCard Policies, which generally require correction on a claim-by-claim or prospective basis.

Appears in 1 contract

Samples: Administrative Services Agreement

Return of Overpayments. Under the BlueCard Program, recoveries Recoveries from a Host Blue or its participating healthcare providers Providers can arise in several ways, including, but not limited to, anti-fraud and abuse recoveries, healthcare providerProvider/hospital audits, credit balance audits, utilization review refunds, and unsolicited refunds. In some cases, the Host Blue will engage a third party parties to assist in identification or collection of recovery amounts. The fees of such a third party may be netted against the recovery. Recovery amounts determined in this way will be applied in accordance with applicable Inter-Plan Programs policies, which generally require correction on a claim-by-claim or prospective basis.

Appears in 1 contract

Samples: Administrative Services Agreement

AutoNDA by SimpleDocs

Return of Overpayments. Under the BlueCard ProgramBlueCard, recoveries from a Host Blue or its from participating healthcare providers of a Host Blue can arise in several ways, including, but not limited to, anti-fraud and abuse recoveriesaudits, healthcare provider/hospital audits, credit balance audits, utilization review refunds, and unsolicited refunds. In some cases, the Host Blue will engage a third party parties to assist in identification discovery or collection of recovery amounts. The fees of such a third party may be parties are netted against the recovery. Recovery amounts determined in this way amounts, net of fees, if any, will be applied in accordance with applicable Inter-Plan Programs policiesBlueCard Policies, which generally require correction on a claim-by-claim or prospective basis.

Appears in 1 contract

Samples: Sales Agreement

Return of Overpayments. Under the BlueCard Program, recoveries from a Host Blue or its participating healthcare providers Participating/In-Network Providers can arise in several ways, including, but not limited to, anti-fraud and abuse recoveries, healthcare provider/hospital audits, credit balance audits, utilization review refunds, and unsolicited refunds. In some cases, the Host Blue will engage a third party to assist in identification or collection of recovery amounts. The fees of such a third party may be netted against the recovery. Recovery amounts determined in this way will be applied in accordance with applicable Inter-Plan Programs policies, which generally require correction on a claim-by-claim or prospective basis.

Appears in 1 contract

Samples: Master Group Agreement

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