Third Party Payors. A. Except as provided in this Grant Agreement, Grantee shall screen all clients and may not bill the System Agency for services eligible for reimbursement from third party payors, who are any person or entity who has the legal responsibility for paying for all or part of the services provided, including commercial health or liability insurance carriers, Medicaid, or other federal, state, local and private funding sources.
B. As applicable, the Grantee shall:
i. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement that may be covered by those programs and bill those programs for the covered services;
ii. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third party payor, to receive services and bill the System Agency for the deductible;
iv. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. Xxxx all third party payors for services provided under this Grant Agreement before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Third Party Payors. Company, Shareholders and each licensed professional employee or independent contractor of Company has timely filed all claims or other reports required to be filed with respect to the purchase of services by third-party payors, and all such claims or reports are complete and accurate, and has no liability to any payor with respect thereto. There are no pending appeals, overpayment determinations, adjustments, challenges, audit, litigation or notices of intent to open Medicare or Medicaid claim determinations or other reports required to be filed by Company, any Shareholder and each licensed professional employee of Company. Neither Company, nor any Shareholder, nor any licensed professional employee of Company has been convicted of, or pled guilty or nolo contendere to, patient abuse or negligence, or any other Medicare or Medicaid program related offense and none has committed any offense which may serve as the basis for suspension or exclusion from the Medicare and Medicaid programs or any other third party payor program. With respect to payors, Company, Shareholders and Company's licensed professional employees has not (a) knowingly and willfully making or causing to be made a false statement or representation of a material fact in any application for any benefit or payment; (b) knowingly and willfully making or causing to be made any false statement or representation of a material fact for use in determining rights to any benefit or payment; (c) failed to disclose knowledge of the occurrence of any event affecting the initial or continued right to any benefit or payment on its own behalf or on behalf of another, with the intent to fraudulently secure such benefit or payment; and (d) violated any applicable state anti-remuneration or self-referral statutes, rules or regulations.
Third Party Payors. Except as provided in this Contract, Contractor shall screen all clients and may not bill the System Agency for services eligible for reimbursement from third party payors, who are any person or entity who has the legal responsibility for paying for all or part of the services provided, including commercial health or liability insurance carriers, Medicaid, or other federal, state, local and private funding sources. As applicable, the Contractor shall:
a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Contract that may be covered by those programs and bill those programs for the covered services;
b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
c. Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third party payor, to receive services up to the amount of the deductible and to bill the System Agency for the deductible;
d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
f. Xxxx all third party payors for services provided under this Contract before submitting any request for reimbursement to System Agency; and
g. Provide third party billing functions at no cost to the client. S ECTION 1.11 MEDICAL RECORDS RETENTION Contractor shall retain medical records in accordance with 22 TAC §165.1(b) or other applicable statutes, rules and regulations governing medical information.
Third Party Payors. There is no threatened or pending revocation, suspension, termination, probation, restriction, limitation, or nonrenewal affecting Borrower, Manager or the Facility or any participation or provider agreement with any third-party payor, including Medicare, Medicaid, Blue Cross and/or Blue Shield, and any other private commercial insurance managed care and employee assistance program (such programs, the “Third-Party Payors’ Programs”) to which Borrower or Manager presently is subject. All Medicare (if any), Medicaid (if any) and private insurance cost reports and financial reports submitted by Borrower or Manager are and will be materially accurate and complete and have not been and will not be misleading in any material respects. No cost reports for the Facility remain “open” or unsettled except as otherwise disclosed.
Third Party Payors. 1. Not seek reimbursement from System Agency if the individual is covered by a third-party payor.
2. Demonstrate the capacity to bill insurance, Medicaid, and/or Medicare for individuals with health insurance coverage.
i. Contract with Medicaid and the identified Managed Care Organizations in service delivery Region
ii. Contract with Medicare in the service delivery Region.
3. Refer individuals to a treatment Program that is approved by the individual’s third-party payor if Grantee is not eligible for reimbursement.
i. If the approved treatment Program refuses treatment services to the Client and documents that refusal, Grantee may provide treatment services and bill System Agency;
ii. The refusal, including third-party payor and approved treatment Program, is documented in the Client file;
(1) The Client meets the diagnostic criteria for substance use disorder; and
(2) If Client’s third-party payor would cover or approves partial or full payment for treatment services, Grantee may bill System Agency for the non-reimbursed costs, including the deductible, provided:
a. The Client’s parent/guardian refuses to file a claim with the third party payor, or refuses to pay either the deductible or the non-reimbursed portion of the cost of treatment, and Respondent has obtained a signed statement from the parent/guardian of refusal to pay, and Xxxxxxx has received written approval from the System Agency substance use disorder treatment Program services clinical coordinator to bill for the deductible or non-reimbursed portion of the cost;
b. The Client or parent/guardian cannot afford to pay the deductible or the non- reimbursed portion of the cost of treatment; or
c. The Client or parent/guardian has an adjusted income at or below200% of the Federal poverty guidelines.
iii. If a Client has exhausted all insurance coverage and requires continued treatment, Grantee may provide the continued treatment services and bill System Agency if the Client meets Section II (C) 1-3.
Third Party Payors. Except as provided in this Contract, Grantee shall screen all clients and may not bill the System Agency for services eligible for reimbursement from third party payors, who are any person or entity who has the legal responsibility for paying for all or part of the services provided, including commercial health or liability insurance carriers, Medicaid, or other federal, state, local and private funding sources. As applicable, the Grantee shall: Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Contract that may be covered by those programs and bill those programs for the covered services; Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs; Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third party payor, to receive services and bill the System Agency for the deductible; Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted; Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement; Xxxx all third party payors for services provided under this Contract before submitting any request for reimbursement to System Agency; and Provide third party billing functions at no cost to the client. Grantee shall retain medical records in accordance with 22 TAC §165.1(b) or other applicable statutes, rules and regulations governing medical information. Prior to or on the expiration date of this Contract, the Parties agree that this Contract can be extended as provided under this section. The System Agency shall provide written notice of interim extension amendment to the Grantee under one of the following circumstances: Continue provision of services in response to a disaster declared by the governor; or To ensure that services are provided to clients without interruption. The System Agency will provide written notice of the interim extension amendment that specifies the reason for it and period of time for the extension. Grantee will provide and invoice for services in the same manner that is stated in the Grant Agreement/Contract. An interim extension under subsection (B)(i) of this section shall extend the term of the Contract not longer than 30 days after governor's disaster declaration is declared unless the Pa...
Third Party Payors. Section 4.30 of the Disclosure Schedule sets forth an accurate, correct and complete list of the Company’s third-party payors. Neither the Company nor the Shareholder has received any notice nor has any Knowledge that any third-party payor intends to terminate or materially reduce its business with, or reimbursement to, the Company. The Company has no reason to believe that any third-party payor will cease to do business with the Company after, or as a result of, the consummation of any transactions contemplated hereby. The Company does not know of any fact, condition or event which would adversely affect its relationship with any third-party payor.
Third Party Payors. Except as described in the Registration Statement, the Prospectus and the Pricing Disclosure Package or as would not, individually or in the aggregate, be reasonably expected to result in a Material Adverse Effect, the accounts receivable of the Company and each of its subsidiaries and JVs have been adjusted to reflect contractual allowances provided to third-party payors, private insurance companies, health maintenance organizations, preferred provider organizations, alternative delivery systems, managed care systems, government contracting agencies and other third-party payors and the rates established by governmental payors, including Medicare, Medicaid and, in some instances, for workers’ compensation claims. In particular, accounts receivable relating to such third-party payors do not exceed amounts any obligee is entitled to receive under any capitation arrangement, fee schedule, discount formula, cost-based reimbursement or other adjustment or limitation to its usual charges.
Third Party Payors. A third party payor is any person or entity who has the legal responsibility for paying for all or part of the services provided, including commercial health or liability insurance carriers, Medicaid, or other federal, state, local and private funding sources. Except as provided in this Contract, Contractor shall screen all clients and shall not bill the Department for services eligible for reimbursement from third party payors. Contractor shall: Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Contract that may be covered by those programs and bill those programs for the covered services; Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs; Allow clients that are otherwise eligible for Department services, but cannot pay a deductible required by a third party payor, to receive services up to the amount of the deductible and to bill the Department for the deductible; Not bill the Department for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted, in which case the 30-day requirement in the Billing Submission section shall be extended until all such appeals have been exhausted; Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement; Xxxx all third party payors for services provided under this Contract before submitting any request for reimbursement to Department; and Provide third party billing functions at no cost to the client.
Third Party Payors. Dentist and each licensed professional employee or independent contractor of Dentist has timely filed all claims or other reports required to be filed with respect to the purchase of services by third-party payors, and all such claims or reports are complete and accurate, and has no liability to any payor with respect thereto. There are no pending appeals, overpayment determinations, adjustments, challenges, audit, litigation or notices of intent to open Medicare or Medicaid claim determinations or other reports required to be filed by Dentist and each licensed professional employee of Dentist. Neither Dentist nor any licensed professional employee of Dentist has been convicted of, or pled guilty or nolo contendere to, patient abuse or negligence, or any other Medicare or Medicaid program related offense and none has committed any offense which may serve as the basis for suspension or exclusion from the Medicare and Medicaid programs or any other third party payor program. With respect to payors, Dentist and Dentist's licensed professional employees have not (a) knowingly and willfully making or causing to be made a false statement or representation of a material fact in any application for any benefit or payment; (b) knowingly and willfully making or causing to be made any false statement or representation of a material fact for use in determining rights to any benefit or payment; (c) failed to disclose knowledge of the occurrence of any event affecting the initial or continued right to any benefit or payment on its own behalf or on behalf of another, with the intent to fraudulently secure such benefit or payment; and (d) violated any applicable state anti-remuneration or self-referral statutes, rules or regulations.
