Common use of Third Party Payors Clause in Contracts

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 Parties agree to a shorter period of time.

Third Party Payors. (a) Neither the Borrower nor any Subsidiary or Minority Investment is in default in the performance, observance, or fulfillment of any of its material obligations, covenants or agreements contained in any Medicare Provider Agreement or any agreement or instrument with any other Third Party Payor, which default has resulted in, or could reasonably be expected to result in, the revocation, termination, cancellation or suspension of the Medicare Certification of such Loan Party or the right of such Loan Party to participate in any other Third Party Payor program. (b) If the Borrower or any of its Subsidiaries, Minority Investments or Professional Services Affiliates has received notice of any existing audit or has been audited by any Third Party Payor, none of such audits provides for material adjustments in reimbursable costs or asserts claims for reimbursement or repayment by such Person of costs and/or payments theretofore made by such Third Party Payor that, if adversely determined, individually or in the aggregate, could reasonably be expected to have a Material Adverse Effect. (c) The Accounts (as defined in the UCC) of the Borrower and its Subsidiaries, Minority Investments and Professional Services Affiliates have been and will continue to be adjusted to reflect the reimbursement policies of its Third Party Payors in all material respects. In particular, none of the Borrower and its Subsidiaries, Minority Investments and Professional Services Affiliates Accounts is knowingly retaining, or having knowingly retained, any overpayments in violation of applicable Healthcare Laws. (d) Except as provided in this Contractset forth on Schedule 5.27, 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 as of the services providedClosing Date, including commercial health the Borrower and its Subsidiaries, Minority Investments and Professional Services Affiliates have the requisite supplier or liability insurance carriersprovider number or other authorization to xxxx the Medicare program and all other Third Party Payor Programs that the Borrower or such Subsidiary or Minority Investment bills as a participating or in-network provider. Except as set forth on Schedule 5.27, Medicaidthere is no investigation, audit, claim review, or other federalaction pending or, stateto the knowledge of the Loan Parties, local threatened, which would be reasonably likely to result in a revocation, suspension, termination, probation, restriction, limitation, adverse amendment or non-renewal of any Third Party Payor supplier or provider number or result in any of the Companies’ exclusion from any Third Party Payor Program. All bills and private funding sources. As applicableclaims (collectively, “Loan Party Claims”) submitted by or on behalf of the Grantee shall: Enroll as a provider in Children’s Health Insurance Program Borrower and Medicaid if providing approved its Subsidiaries, Minority Investments and Professional Services Affiliates for items, services authorized under this Contract that may be and goods provided to patients whose care is covered by those programs Third Party Payors represent claims for items, services or goods actually provided by the Borrower or such Subsidiary or Minority Investment. All Loan Party Claims that have been submitted by or on behalf of the Borrower and bill those programs its Subsidiaries, Minority Investments and Professional Services Affiliates have been submitted in material compliance with applicable Laws and all rules, regulations, policies, and procedures of the Third Party Payors. To the knowledge of the Loan Parties, there are no pending or threatened, audits, investigations or claims for or relating to Loan Party Claims that would result in a Material Adverse Effect. (e) All amounts received by the covered services; Provide assistance Borrower and its Subsidiaries, Minority Investments and Professional Services Affiliates from patients and Third Party Payors are the result of valid Loan Party Claims and are in amounts to individuals to enroll in such programs when which the screening process indicates possible eligibility for such programs; Allow clients that Borrower or the applicable Subsidiaries, Minority Investments or Professional Services Affiliates are otherwise eligible for System Agency services, but cannot pay a deductible required by a third party payor, entitled to receive services under applicable Law 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 applicable Third Party Payor Agreements, subject to the client. Grantee shall retain medical records refunds and overpayments are made to the owed party or escheated to the applicable state in accordance with 22 TAC §165.1(b) or other applicable statutesLaw and any applicable Third Party Payor Agreements requirements, rules and regulations governing medical information. Prior except as would not be reasonably likely 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 result 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 Parties agree to a shorter period of timeMaterial Adverse Effect.