Submission and Payment of Claims. The Escrow Agent shall release Settlement Funds from the Qualified Settlement Fund to Class Counsel for the benefit of Qualifying Class Members and Class Counsel will cause the Claims Administrator to distribute the Settlement Funds from the Qualified Settlement Fund to Qualifying Class Members, consistent with the payment provisions set forth in Section 6 and Exhibits A and H.
Submission and Payment of Claims. Provider shall not submit claim or encounter data for services covered by the Alliance Tailored Plan directly to the Department. Provider shall submit all claims for processing and Alliance shall process and pay claims in accordance with the following terms and conditions.
a. If Alliance denies payment of a claim, Alliance shall provide Provider the ability to electronically access the specific denial reason.
b. Status of a claim shall be available within five to seven (5-7) days of Alliance’s receipt of the claim.
c. Alliance is not limited to approving a claim in full or requesting additional information for the entire claim. Rather, as appropriate, Alliance may approve a claim in part, deny a claim in part, and/or request additional information for only a part of the claim.
d. Alliance will not reimburse Provider for services provided by staff not meeting licensure, certification or accreditation requirements.
e. Provider agrees to send 837 HIPAA compliant transactions and to receive 835 Remittances or to participate in Alliance's web based billing process.
f. Claims must be submitted electronically either through HIPAA Compliant Transaction Sets 820 – Premium Payment, 834 – Member Enrollment and Eligibility Maintenance, 835 – Remittance Advice, 837P – Professional claims, 837I – Institutional claims, or Alliance’s secure web based billing system. Provider will notify Alliance if electronic submission is not possible for a particular claim, and the Parties will work cooperatively to facilitate manual submission of the claim if necessary.
g. Provider’s claims shall be compliant with the National Correct Coding Initiative effective on the date of service.
h. Both Parties shall be compliant with the requirements of the National Uniform Billing Committee.
i. Provider may submit claims beyond one-hundred-eighty (180) days in instances where the Recipient has been retroactively enrolled in the NC Medicaid Program or in the BH I/DD Tailored Plan, or where the Recipient has primary insurance which has not yet paid or denied its claim. In such instances, Provider should bill Alliance within thirty (30) days of receipt of notice by the Provider of the Recipient’s eligibility, or within ninety (90) days of final action (including payment or denial) by the primary insurance or Medicare or the date of service or discharge (whichever is later).
j. If Provider delays submission of the claims due to the coordination of benefits, subrogation of benefits or the determina...
Submission and Payment of Claims. A. Claims - Unless otherwise mutually agreed, a claim for loss may be filed with the Company on the appropriate form provided by the Company within sixty (60) days after the Insured has conveyed title to the property pursuant to an Approved Sale and shall be accompanied by such documents and other information as are reasonably requested by the Company. The Company shall not unreasonably withhold the approval necessary for such an Approved Sale.
B. Failure to File - Failure to file a claim for loss within sixty (60) days after a claim could first be filed under Condition 8A above shall be deemed an election by the Insured to waive any rights to claim payment under the terms of this Policy.
C. Loss Payments - Any payment of loss required to be made to the Insured with respect to any claim shall be payable within sixty (60) days after receipt by the Company of such claim, provided that, if the Company shall within twenty (20) days after the filing of the claim request additional information necessary to complete its review of the claim, then the sixty (60) day period shall be suspended until the Company receives the requested information.
Submission and Payment of Claims. 8.4.1. Fourteen (14) calendar days after the Effective Date, the Escrow Agent shall re- lease all funds remaining in the Settlement Fund to Class Counsel for the benefit of the Settlement Class.
8.4.2. Within thirty (30) calendar days of the Effective Date, Class Counsel will cause the Settlement Administrator to distribute all of the res remaining in the Settlement Fund to Class Members who have submitted valid claims in accordance with the provisions of Paragraph 8.3 and have not exercised the right to opt out through ap- plication of a single allocation formula as specified in Exhibit 5 to this Agreement that allocates a single payment to each Class Member.
Submission and Payment of Claims. Unless otherwise instructed, or required by state or federal law, Provider shall submit Claims to Plan, subject to any applicable HIPAA requirements, using appropriate and current Coded Service Identifier(s), within one hundred eighty (180) days for HMO Colorado and three hundred sixty five (365) days for all other products from the date the Health Services are rendered or Plan will refuse payment. If Plan is the secondary payor, the one hundred eighty (180) or three hundred sixty five (365) day period will not begin until Provider receives notification of primary payor's responsibility.
2.5.1 Provider agrees to provide to Anthem, unless otherwise instructed, at no cost to Anthem, Plan or the Covered Individual, all information necessary for Plan to determine its payment liability. Such information includes, without limitation, accurate and Clean Claims for Covered Services. Once Anthem determines Plan has any payment liability, all Clean Claims will be paid in accordance with the terms and conditions of a Covered Individual's Health Benefit Plan and the PCS.
2.5.2 Provider agrees to submit Claims in a format consistent with industry standards and acceptable to Plan either (a) electronically or (b) if electronic submission is not available, utilizing paper forms.
2.5.3 If Anthem or Plan asks for additional information so that Plan may process the Claim, Provider must provide that information within thirty (30) days. Failure to provide Anthem or Plan with the required information may result in the Claim being denied.
2.5.4 In no event, shall Provider xxxx, collect, or attempt to collect payment from the Covered Individual for Claims Plan receives after the applicable period(s) as set forth above, regardless of whether Plan pays such Claims.
2.5.5 In all events, however, Provider shall only look for payment (except for applicable Cost Share or other obligations of Covered Individuals) from the Plan that provides the Health Benefit Plan for the Covered Individual for Covered Services rendered.
Submission and Payment of Claims. Provider shall xxxx Plan within twelve (12) months from the date Health Services are rendered or Plan may refuse payment. Provider shall submit Claims, with current Coded Service Identifier(s), on the Centers for Medicare and Medicaid Services 1500 (CMS-1500) promulgated by the National Uniform Claim Committee (“NUCC”), or any successor forms promulgated by the NUCC. In addition, all Claims submitted by Provider must also meet any additional billing requirements as set forth in the provider manual. The provider manual provides additional guidance regarding billing requirements (e.g., clarification on billing procedures for special circumstances such as when Plan is secondary). Provider shall furnish, on request, all information reasonably required by Plan to verify and substantiate the Health Services provided by the Provider and the Provider Charges for such Health Services. Plan reserves the right to review all information concerning statements submitted by Provider when necessary.
2.5.1. Provider agrees to provide to Anthem, unless otherwise instructed, at no cost to Anthem, Plan or the Covered Individual, all information necessary for Plan to determine its payment liability. Such information includes, without limitation, accurate and Complete Claims for Covered Services. Once Anthem determines Plan has any payment liability, all Complete Claims will be adjudicated in accordance with the terms and conditions of a Covered Individual’s Health Benefit Plan and the PCS.
2.5.2. Provider agrees to submit Claims in a format consistent with industry standards and acceptable to Plan either (a) electronically or (b) if electronic submission is not available, utilizing paper forms. If Plan is the secondary payor, the twelve (12) month period will not begin until Provider receives notification of primary payor’s responsibility.
2.5.3. If Anthem or Plan asks for additional information so that Plan may process the Claim, Provider must provide that information within sixty (60) days, or before the expiration of the twelve (12) month period referenced above, whichever is longer.
2.5.4. In no event, shall Provider xxxx, collect, or attempt to collect payment from the Covered Individual for Claims Plan receives after the applicable period(s) as set forth above, regardless of whether Plan pays such Claims.
2.5.5. In all events, however Provider shall only look for payment (except for applicable Cost Share or other obligations of Covered Individuals) from the Plan that pro...
Submission and Payment of Claims. A. Claims - Unless otherwise mutually agreed, a claim for loss may be filed with the Company on the appropriate form provided by the Company within sixty (60) days after the Insured has conveyed title to the property pursuant to an Approved Sale and shall be accompanied by such documents and other information as are reasonably requested by the Company. The Company shall not unreasonably withhold the approval necessary for such an Approved Sale.
B. Failure to File - Failure to file a claim for loss within sixty (60) days after a claim could first be filed under Condition 8A above shall result only in a reduction of the Loss to the estimated extent of the prejudice suffered by the Company for the violation, and shall not result in cancellation of coverage with respect to a particular Mortgage Agreement unless the timing violation exceeds one hundred eighty (180) days from the required date of submission.
C. Loss Payments - Any payment of loss required to be made to the Insured with respect to any claim shall be payable within sixty (60) days after receipt by the Company of such claim, provided that, if the Company shall within twenty (20) days after the filing of the claim request additional information necessary to complete its review of the claim, then the sixty (60) day period shall be suspended until the Company receives the requested information.
Submission and Payment of Claims. 31.1. Medical Consultation Subclass (Subclass 1)
31.1.1. The Medical Consultation Fund portion of the Settlement Fund, which shall consist of the payments described in Paragraphs 19.1.1, 19.2, 19.3 and 19.4, shall be used to pay for medical consultation expenses for Plaintiffs and Class Members of Subclass 1, as well as costs consistent with the Medical Consultation Program outlined in this Agreement.
31.1.2. In order to substantiate a claim with the Claims Administrator, Class Members of Subclass 1 shall be required to provide a Claim Form consistent with Section 30, and including their full names, dates of birth, social security numbers (if available), dates of residence at the subject MHP, and unit number within the subject MHP during residency. If necessary to verify a claim once a Class Member’s identifying information is provided, the Class Member’s residence at the subject MHP in a unit included within the class definition set forth in Section 18.1 may be verified by Class Counsel or the Administrator at their discretion. If no independent verification can be made by Class Counsel or the Administrator, then the Class Member may be required to provide two forms of documentation of residence within an included unit consistent with Section 18.1, including but not limited to tax forms, deeds, billing statements, rental or lease agreements, etc., in order to substantiate a claim.
31.1.2.1. Class Members of Subclass 1 who fail to submit a Claim Form on or before the date which falls two (2) years after Final Approval shall not be eligible to participate in the Medical Consultation program thereafter.
31.1.3. Once class status is verified, the verified Class Member shall be eligible to receive the class benefit of Medical Consultation as follows:
31.1.3.1. Each verified Class Member shall be eligible for one (1) medical consultation with a doctor selected by Class Counsel to receive any or all of the following procedures, pursuant to the advice of the selected physician and based on the verified Class Member’s own discretion for the same, intended to screen for medical conditions including those potentially associated with exposure to Trichloroethylene (“TCE”) in very high concentrations (far exceeding any of the indoor air concentrations of TCE ever detected in any residence or building at the MHPs), including kidney cancer, liver cancer, and hematolymphatic cancer: - history and physical examination by board- certified physician - blood chemistry, blood ...
Submission and Payment of Claims. The Provider shall submit all claims for processing and Alliance shall process and pay claims in accordance with the terms set forth in Attachments B and C, which are attached hereto and incorporated herein. Participating Providers shall not submit claim or encounter data for services covered by the Alliance Tailored Plan directly to the Department.
a. If Alliance denies payment of a claim, Alliance shall provide Provider the ability to electronically access the specific denial reason.
b. Status of a claim shall be available within five to seven (5-7) days of Alliance’s receipt of the claim.
c. Alliance is not limited to approving a claim in full or requesting additional information for the entire claim. Rather, as appropriate, Alliance may approve a claim in part, deny a claim in part, and/or request additional information for only a part of the claim.
Submission and Payment of Claims
