Third Party Billing. If, prior to the Effective Date or at any time during the term of this IA LFAC contracts with a third party billing company to submit claims to the Federal health care programs on behalf of LFAC, LFAC must certify to OIG that he or it does not have an ownership or control interest (as defined in 42 U.S.C. § 1320a-3(a)(3)) in the third party billing company and is not employed by, and does not act as a consultant to, the third party billing company. LFAC also shall obtain (as applicable) a certification from any third party billing company that the company: (i) has a policy of not employing any person who is excluded from participation in any Federal health care program to perform any duties related directly or indirectly to the preparation or submission of claims to Federal health care programs; (ii) screens its prospective and current employees against the Exclusion List; and (iii) provides training in the applicable requirements of the Federal health care programs to those employees involved in the preparation and submission of claims to Federal health care programs. If applicable, a copy of these certifications shall be included in LFAC’s Implementation Report and each Annual Report required by Section V below.
Third Party Billing. If, prior to the Effective Date or at any time during the term of this IA Xxxxx contracts with a third party billing company to submit claims to the Federal health care programs on behalf of Xxxxx, Xxxxx must certify to OIG that he does not have an ownership or control interest (as defined in 42 U.S.C. § 1320a-3(a)(3)) in the third party billing company and is not employed by, and does not act as a consultant to, the third party billing company. Xxxxx also shall obtain (as applicable) a certification from any third party billing company that the company: (i) has a policy of not employing any person who is excluded, debarred, suspended or otherwise ineligible to participate in Medicare or other Federal health care programs to perform any duties related directly or indirectly to the preparation or submission of claims to Federal health care programs; (ii) screens his prospective and current employees against the HHS/OIG List of Excluded Individuals/Entities and the General Services Administration’s System for Award Management; and (iii) provides training in the applicable requirements of the Federal health care programs to those employees involved in the preparation and submission of claims to Federal health care programs. If applicable, a copy of these certifications shall be included in Xxxxx’s Implementation Report and each Annual Report required by Section V below.
Third Party Billing. If, prior to the Effective Date or at any time during the term of this IA Xx. Xxxxxx contracts with a third party billing company to submit claims to the Federal health care programs on behalf of Xx. Xxxxxx or MRA, Xx. Xxxxxx must certify to OIG that he does not have an ownership or control interest (as defined in 42 U.S.C. § 1320a-3(a)(3)) in the third party billing company and is not employed by, and does not act as a consultant to, the third party billing company.
Third Party Billing. The Managing Entity shall adhere to the following guidelines for payment of services billed by Network Service Providers:
2.9.1 Department funds may not reimburse services provided to:
2.9.1.1 Individuals who have third party insurance coverage when the services provided are paid under the insurance plan; or
2.9.1.2 Medicaid enrollees or recipients of another publicly funded health benefits assistance program, when the services provided are paid by said program.
Third Party Billing. If, prior to the Effective Date or at any time during the term of this IA Xxxxx contracts with a third party billing company to submit claims to the Federal health care programs on behalf of Xxxxx, Xxxxx must certify to OIG that it does not have an ownership or control interest (as defined in 42 U.S.C. § 1320a-3(a)(3)) in the third party billing company. Xxxxx also shall obtain (as applicable) a certification from any third party billing company that the company: (i) has a policy of not employing any person who is excluded from participation in any Federal health care program to perform any duties related directly or indirectly to the preparation or submission of claims to Federal health care programs; (ii) screens its prospective and current employees against the Exclusion List ; and (iii) provides training in the applicable requirements of the Federal health care programs to those employees involved in the preparation and submission of claims to Federal health care programs. If applicable, a copy of these certifications shall be included in Kelly’s Implementation Report and each Annual Report required by Section V below.
Third Party Billing. The Subcontractor shall adhere to the following guidelines when billing Managing Entity:
a. Services are not reimbursable for the following:
1. Individuals who have third party insurance coverage when the services provided are paid under the insurance plan; or
2. Medicaid enrollees or recipients of another publicly funded health benefits assistance program, when the services provided are paid by said program.
b. Services are reimbursable for the following:
1. Individuals who have lost coverage through Medicaid, or any other publicly funded health benefits assistance program coverage for any reason during the period of non-coverage; or
2. Individuals who have a net family income less than 150 percent of the Federal Poverty Income Guidelines, subject to the sliding fee scale requirements in Rule 65E-14.018 F.A.C.
Third Party Billing. If the Distributor appoints a Generator or another retailer as its billing service provider, the Distributor will put all procedures in place that are necessary to ensure the Generator or the other retailer (as the case may be) does not use or pass on any Confidential Information supplied by the Retailer, except for the purposes expressly permitted by this agreement. The Retailer may appoint an independent, appropriately qualified, person to audit the procedures of the third party to ensure compliance with this clause. Such audit may not occur more than once in any 12 month period unless any audit report states that the procedures are not adequate or are not being observed in which case, without affecting any other rights of the Retailer, the Retailer may request an audit once every 3 months until the Retailer receives two audit reports confirming that the procedures are adequate and are being observed. The Distributor will ensure that the auditor is given full co- operation by the third party being audited including that the third party does not delay or restrict the audit. The costs of the audit will be met by the Retailer unless the auditor determines that the procedures are not adequate or are not being observed, in which case the cost of the audit and each successive audit until two audit reports have been received by the Retailer confirming that the procedures are adequate and are being observed, will be met by the Distributor.
Third Party Billing a. The Managing Entity and the Department are intended to be Payors of last resort. The Network Service Provider shall adhere to the following guidelines for payment and billing:
(1) The Network Service Provider shall not bill the Managing Entity for services provided to:
(a) Individuals who have third party insurance coverage when the services provided are paid under the insurance plan; or
(b) Recipients of Medicaid, or another publicly funded health benefits assistance program, when the services provided are paid by said program.
(2) The Network Service Provider shall comply with the terms and conditions of 65E- 14, F.A.C. in determining which individuals to bill to the Managing Entity.
b. The Network Service Provider shall report Medicaid earnings and earnings from other publicly funded health benefits assistance programs separately from all other fees.
Third Party Billing. If, prior to the Effective Date or at any time during the term of this IA Xxxxxx contracts with a third party billing company to submit claims to the Federal health care programs on behalf of Xxxxxx, Xxxxxx X. Xxxxxx, D.O., Xxxxx Xxxxxx, Dermatology Healthcare, LLC, and Xxxxxx X. Xxxxxx, D.O., P.A. must certify to OIG that they do not have an ownership or control interest (as defined in 42 U.S.C. § 1320a-3(a)(3)) in the third party billing company and is not employed by, and does not act as a consultant to, the third party billing company. Xxxxxx also shall obtain (as applicable) a certification from any third party billing company that the company: (i) has a policy of not employing any person who is excluded from participation in any Federal health care program to perform any duties related directly or indirectly to the preparation or submission of claims to Federal health care programs; (ii) screens its prospective and current employees against the Exclusion List; and (iii) provides training in the applicable requirements of the Federal health care programs to those employees involved in the preparation and submission of claims to Federal health care programs. If applicable, a copy of these certifications shall be included in Xxxxxx’x Implementation Report and each Annual Report required by Section V below.
Third Party Billing. If, prior to the Effective Date or at any time during the term of this IA Xxxxxx contracts with a third party billing company to submit claims to the Federal health care programs on behalf of Xxxxxx, Xxxxxx must certify to OIG that it does not have an ownership or control interest (as defined in 42 U.S.C. § 1320a-3(a)(3)) in the third party billing company and is not employed by, and does not act as a consultant to, the third party billing company. Xxxxxx also shall obtain (as applicable) a certification from any third party billing company that the company: (i) has a policy of not employing any person who is excluded from participation in any Federal health care program to perform any duties related directly or indirectly to the preparation or submission of claims to Federal health care programs; (ii) screens its prospective and current employees against the Exclusion List; and (iii) provides training in the applicable requirements of the Federal health care programs to those employees involved in the preparation and submission of claims to Federal health care programs. If applicable, a copy of these certifications shall be included in Xxxxxx’x Implementation Report and each Annual Report required by Section V below.
