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.
Appears in 59 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant Agreement/Contract, Grantee Grantee/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.
B. As applicable, the Grantee Grantee/Contractor shall:
i. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Agreement/Contract 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 Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 45 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 26 contracts
Samples: Grant Agreement, Grant Agreement, Health and Human Services Contract
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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. (a) Enroll as a Medicaid provider, or enter into a network provider in agreement with a Children’s Health Insurance Program and Medicaid if Managed Care Organization (MCO) under terms and conditions that are mutually-agreeable to the Grantee and MCO. If providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and Medicaid or CHIP, the Grantee will bill those programs or contracted MCOs for the covered services;
ii. (b) 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. (c) Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. (d) Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. (e) Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. (f) Provide third party billing functions at no cost to the client.
Appears in 25 contracts
Samples: Health and Human Services Contract, Health and Human Services Contract, Health and Human Services Contract
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee 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.
B. . As applicable, the Grantee Contractor shall:
i. (a) Enroll as a Medicaid provider, or enter into a network provider in agreement with a Children’s Health Insurance Program and Medicaid if Managed Care Organization (MCO) under terms and conditions that are mutually-agreeable to the Grantee and MCO. If providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and Medicaid or CHIP, the Grantee will bill those programs or contracted MCOs for the covered services;
ii. (b) 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. (c) Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. (d) Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. (e) Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. (f) Provide third party billing functions at no cost to the client.
Appears in 21 contracts
Samples: Community Mental Health Grant Contract, Grant Agreement, Interlocal Cooperation Contract
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.
Appears in 20 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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. a. Enroll as a provider in Children’s 's Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 16 contracts
Samples: Contract for Opioid Treatment Services, Grant Agreement, Grant Contract
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee 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.
B. . As applicable, the Grantee Contractor shall:
i. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 14 contracts
Samples: Contract for Tuberculosis Prevention and Elimination Services, Contract for Tuberculosis Prevention and Elimination Services, Contract for Tuberculosis Prevention and Elimination Services
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 Medicaid, if providing approved services authorized under this Grant Agreement that may be covered by those programs 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.
Appears in 12 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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 Children s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract 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 Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 9 contracts
Samples: Medication Assisted Treatment Contract, Treatment for Adults Contract, Health and Human Services Contract
Third Party Payors. A. Except as provided in this Grant Agreement/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.
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 Agreement/Contract 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 Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 9 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. c. Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third third-party payor, to receive services up to the amount of the deductible and to bill the System Agency for the deductible;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third third-party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third third-party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 8 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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. a. Enroll as a provider in Children’s 's Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. c. Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third third-party payor, to receive services up to the amount of the deductible and to bill the System Agency for the deductible;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third third-party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third third-party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 7 contracts
Samples: Grant Agreement, Hiv Prevention Services Grant Contract, Hiv Prevention Services Grant
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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 Contract 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 Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 5 contracts
Samples: Neonatal Abstinence Syndrome Medication Assisted Treatment Contract, Health and Human Services Commission Contract, Neonatal Abstinence Syndrome – Medicated Assisted Treatment Contract
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. 1. 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;
ii2. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii3. Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third third-party payor, to receive services and bill the System Agency for the deductible;
iv4. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. 5. Maintain appropriate documentation from the third third-party payor reflecting attempts to obtain reimbursement;
vi6. Xxxx all third third-party payors for services provided under this Grant Agreement before submitting any request for reimbursement to System Agency; and
vii7. Provide third party billing functions at no cost to the clienttheclient.
Appears in 5 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant Agreement/Contract, Grantee Grantee/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.
B. As applicable, the Grantee Grantee/Contractor shall:
i. Enroll as a provider in Children’s 's Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Agreement/Contract 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 Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 4 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee shall screen all clients and may not bill xxxx 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. a. Enroll as a provider in Children’s 's Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill xxxx those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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 bill to xxxx the System Agency for the deductible;
iv. d. Not bill xxxx the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 4 contracts
Samples: Hiv/Hopwa Contract, Hiv/Rw Contract, Hiv/Hopwa Contract
Third Party Payors. A. i. 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. ii. As applicable, the Grantee shall:
i. 1) 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. 2) Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 3) 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. 4) Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. 5) Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. 6) Xxxx all third party payors for services provided under this Grant Agreement before submitting any request for reimbursement to System Agency; and
vii. 7) Provide third party billing functions at no cost to the client.
Appears in 3 contracts
Samples: Grant Agreement, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee 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.
B. . As applicable, the Grantee Contractor shall:
i. (a) Enroll as a provider in Children’s 's Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. (b) Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. (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;
iv. (d) Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. (e) Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. (f) Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. (g) Provide third party billing functions at no cost to the client.
Appears in 3 contracts
Samples: Interagency Cooperation Contract, Contract for Opioid Treatment Services, Contract for Opioid Treatment Services
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee 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.
B. . As applicable, the Grantee Contractor shall:
i. (a) Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. (b) Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. (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;
iv. (d) Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. (e) Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. (f) Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. (g) Provide third party billing functions at no cost to the client.
Appears in 3 contracts
Samples: Primary Health Care Contract, Primary Health Care Contract, Primary Health Care Contract
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 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.
Appears in 3 contracts
Samples: Health and Human Services Commission Contract, Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant Agreement/Contract, Grantee Grantee/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.
B. As applicable, the Grantee Grantee/Contractor shall:
i. Enroll as a provider in Children’s Children s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Agreement/Contract 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 Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 2 contracts
Samples: Grant Agreement, Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee Contractor shall screen all clients and may not bill xxxx the System Agency Department 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 Contractor shall:
i. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill xxxx those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. c. Allow clients that are otherwise eligible for System Agency Department services, but cannot pay a deductible required by a third party payor, to receive services up to the amount of the deductible and bill to xxxx the System Agency Department for the deductible;
iv. d. Not bill xxxx the System Agency Department for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System AgencyDepartment; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 2 contracts
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee Contractor shall screen all clients and may not bill the System Agency for services eligible for reimbursement from third 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 Contractor shall:
i. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 2 contracts
Samples: Interagency Cooperation Contract, Interagency Cooperation Contract
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee Contractor shall screen all clients and may not bill the System Agency Department 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 Contractor shall:
i. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. c. Allow clients that are otherwise eligible for System Agency 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 System Agency Department for the deductible;
iv. d. Not bill the System Agency Department for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System AgencyDepartment; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 2 contracts
Samples: Health and Human Services Contract, Contract
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee shall screen all clients and may not bill xxxx the System Agency for services eligible for reimbursement from third 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. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill xxxx those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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 bill to xxxx the System Agency for the deductible;
iv. d. Not bill xxxx the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Interagency Cooperation Contract
Third Party Payors. A. Except as provided in this Grant Agreement/Contract, Grantee Grantee/Contractor shall screen all clients and may not bill xxxx 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 Grantee/Contractor shall:
i. Enroll as a provider in Children’s 's Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Agreement/Contract that may be covered by those programs and bill xxxx 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 xxxx the System Agency for the deductible;
iv. Not bill xxxx 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 Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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. A. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. B. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. C. Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third third-party payor, to receive services up to the amount of the deductible and to bill the System Agency for the deductible;
iv. D. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. E. Maintain appropriate documentation from the third third-party payor reflecting attempts to obtain reimbursement;
vi. F. Xxxx all third third-party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. G. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
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
and vii. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee Performing Agency 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 Performing Agency shall:
i. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
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 Bill 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.
Appears in 1 contract
Samples: Grant Agreement
Third Party Payors. A. i. 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. ii. As applicable, the Grantee shall:
i. 1) Enroll as a provider in Children’s '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. 2) Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 3) 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. 4) Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. 5) Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. 6) Xxxx all third party payors for services provided under this Grant Agreement before submitting any request for reimbursement to System Agency; and
vii. 7) Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
Third Party Payors. A. Except as provided in this Grant Agreement/Contract, Grantee Grantee/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.
B. As applicable, the Grantee Grantee/Contractor shall:
i. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Agreement/Contract 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 Bill all third party payors for services provided under this Grant Agreement Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee Performing Agency shall screen all clients and may not bill the System Agency for services eligible for reimbursement from third 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 Performing Agency shall:
i. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Interagency Cooperation Contract
Third Party Payors. A. Except as provided in this Grant AgreementContract, Grantee if Services provided by Contractor under the Contract so require, Contractor shall screen all clients and may not bill the System Agency for services eligible for reimbursement from third 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 Contractor shall:
i. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. 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;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. f. Xxxx all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Interagency Cooperation Contract
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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 Contract 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 Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
Third Party Payors. A. Except as provided in this Grant Agreement/Contract, Grantee Grantee/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.
B. As applicable, the Grantee Grantee/Contractor shall:
i. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Agreement/Contract 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 Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
Third Party Payors. A. Except as provided in this Grant AgreementContract, 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. a. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Contract that may be covered by those programs and bill those programs for the covered services;
ii. b. Provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. c. Allow clients that are otherwise eligible for System Agency services, but cannot pay a deductible required by a third third-party payor, to receive services up to the amount of the deductible and to bill the System Agency for the deductible;
iv. d. Not bill the System Agency for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. e. Maintain appropriate documentation from the third third-party payor reflecting attempts to obtain reimbursement;
vi. Xxxx f. Bill all third third-party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System Agency; and
vii. g. Provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Grant Agreement
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 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.
Appears in 1 contract
Samples: Grant Agreement
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 A third party payors, who are 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 local, and private funding sources.
B. As applicable. Except as provided in the Contract, Contractor shall screen all clients and shall not bill the Grantee Department for services eligible for reimbursement from third party payors. Contractor shall:
i. Enroll : (a) enroll as a provider in Children’s Health Insurance Program Plan and Medicaid if providing approved services authorized under this Grant Agreement the Contract that may be covered by those programs programs, and bill those programs plans for the covered services;
ii. Provide ; (b) provide assistance to individuals to enroll in such programs when the screening process indicates possible eligibility for such programs;
iii. Allow ; (c) allow clients that are otherwise eligible for System Agency 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 System Agency Department for the deductible;
iv. Not ; (d) not bill the System Agency Department for any services eligible for third party reimbursement until all appeals to third party payors have been exhausted;
v. Maintain ; (e) maintain appropriate documentation from the third party payor reflecting attempts to obtain reimbursement;
vi. Xxxx ; (f) bill all third party payors for services provided under this Grant Agreement Contract before submitting any request for reimbursement to System AgencyDepartment; and
vii. Provide and (g) provide third party billing functions at no cost to the client.
Appears in 1 contract
Samples: Performance Contract
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 Agreement/Contract 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.
Appears in 1 contract
Samples: Grant Agreement
Third Party Payors. A. Except as provided in this Grant Agreement/Contract, Grantee Grantee/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.
B. As applicable, the Grantee Grantee/Contractor shall:
i. Enroll as a provider in Children’s Health Insurance Program and Medicaid if providing approved services authorized under this Grant Agreement Agreement/Contract 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 Agreement/Contract before submitting any request for reimbursement to System Agency; and
vii. Provide third party billing functions at no cost to the clienttheclient.
Appears in 1 contract
Samples: Grant Agreement