THIRD PARTY, PRIMARY OR OTHER INSURANCE CLAIMS Sample Clauses

THIRD PARTY, PRIMARY OR OTHER INSURANCE CLAIMS. 32 A. Reimbursement provided through the Contract shall be payment of last resort. Prior to submitting 33 any claim to the Intermediary for reimbursement of Hospital Services provided to an Enrollee, 34 CONTRACTOR shall: 35 1. Use its reasonable best efforts to determine whether the claim is a third party, primary or 36 other insurance covered claim. 37 // 1 2. Bill and use its reasonable best efforts to collect third party, primary or other insurance 2 covered claims to the full extent of such coverage. 3 B. CONTRACTOR shall determine that a claim is not covered, in whole or in part, under any other 4 state or federal medical care program or under any other contractual or legal entitlement including, but 5 not limited to, coverage defined in W&I Section 10020. 6 C. With submission of a claim, CONTRACTOR shall provide proof of denial to the Intermediary, if 7 a third party, primary or other insurance denies coverage of the claim. 8 D. CONTRACTOR shall report to the Intermediary any payments received from a third party, primary 9 or other insurance covered claims. 10 E. The Contract shall not allow for reimbursement of deductibles or co-payments required by an 11 Enrollee’s third party, primary or other insurance coverage. ADMINISTRATOR shall also not reimburse 12 co-payments required by the MSN Program. 13 F. CONTRACTOR shall provide the Intermediary such records and other documentation as the 14 Intermediary may reasonably require to maintain centralized data collection and referral services in 15 support of third party revenue recovery activities. 16 G. Provider Refunds Of Claims Covered By Other Payments 17 1. If CONTRACTOR, through its own efforts, identifies Medi-Cal coverage, third party 18 settlement, primary or other insurance coverage for services reimbursed through the Contract, 19 CONTRACTOR shall, within thirty (30) calendar days of such identification, unless disputed in 20 accordance with subparagraph G.2. below, to reimburse the Intermediary an amount equal to the MSN 21 payment. If Medi-Cal coverage, third party settlement, primary or other insurance coverage is identified 22 due to efforts of Intermediary’s Third Party Recovery Services (Recovery Services) specified in 23 subparagraph G.4. below, CONTRACTOR shall, within thirty (30) calendar days of notice from Recovery 24 Services, unless disputed in accordance with subparagraph G.2. below, reimburse the Intermediary an 25 amount equal to the MSN payment. Third-party settlement payments m...
Sample 1Sample 2See All (5)
AutoNDA by SimpleDocs
THIRD PARTY, PRIMARY OR OTHER INSURANCE CLAIMS. 27 A. Reimbursement provided through the Agreement shall be payment of last resort. Prior to 28 submitting any claim to the Intermediary for reimbursement of Hospital Services provided to an Eligible 29 Person, HOSPITALEnrollee, CONTRACTOR shall: 30 1. Use its reasonable best efforts to determine whether the claim is a third party, primary or 31 other insurance covered claim. 32 2. Xxxx and use its reasonable best efforts to collect third party, primary or other insurance 33 covered claims to the full extent of such coverage. 34 B. HOSPITAL 35 under any other State shall determine that a claim is not covered, in whole or in part, or Federalfederal medical care program or under any other contractual or legal 36 entitlement including, but not limited to, coverage defined in W&I Section 10020. 37 C. With submission of a claim, HOSPITALCONTRACTOR shall provide proof of denial to the 1 Intermediary, if a third party, primary or other insurance denies coverage of the claim. 2 D. HOSPITALCONTRACTOR shall report to the Intermediary any payments received from a third 3 party, primary or other insurance covered claims. 4 E. The Agreement shall not reimburse deductibles and co-payments required 5 by an Eligible Person’sEnrollee’s third party, primary or other insurance coverage. 6 s 7 // 8 // 9 F. HOSPITALCONTRACTOR shall provide the Intermediary such records and other 10 documentation as the Intermediary may reasonably require to maintain centralized data collection and 11 referral services in support of third-party revenue recovery activities.
Sample 1
THIRD PARTY, PRIMARY OR OTHER INSURANCE CLAIMS. 23 A. Reimbursement provided through this Agreement shall be payment of last resort. Prior to 24 submitting any claim to the Intermediary for reimbursement of Hospital Services provided to an Eligible 25 Person, HOSPITAL shall: 26 1. Use its reasonable best efforts to determine whether the claim is a third party, primary or 27 other insurance covered claim. 28 2. Xxxx and use its reasonable best efforts to collect third party, primary or other insurance 29 covered claims to the full extent of such coverage. 30 B. HOSPITAL shall determine that a claim is not covered, in whole or in part, under any other 31 State or Federal medical care program or under any other contractual or legal entitlement including, but 32 not limited to, coverage defined in W&I Section 10020. 33 C. With submission of a claim, HOSPITAL shall give proof of denial to the Intermediary, if a third 34 party, primary or other insurance denies coverage of the claim. 35 D. HOSPITAL shall report to the Intermediary any payments received from a third party, primary 36 or other insurance covered claims. 37 // 1 //
Sample 1
THIRD PARTY, PRIMARY OR OTHER INSURANCE CLAIMS. Reimbursement provided through the Agreement shall be payment of last resort. Prior to 31 submitting any claim to the Intermediary for reimbursement of Hospital Services provided to an Eligible 32 Person, HOSPITAL shall:
Sample 1
THIRD PARTY, PRIMARY OR OTHER INSURANCE CLAIMS. Reimbursement provided through the Agreement shall be payment of last resort. Prior to 21 submitting any claim to the Intermediary for reimbursement of Clinic Services provided to an Enrollee, 22 CONTRACTOR shall:
Sample 1

Related to THIRD PARTY, PRIMARY OR OTHER INSURANCE CLAIMS

  • Third Party Liability Insurance Article 30 - Discipline

  • Other Insurances Contractor may be required to carry additional insurance based upon the nature of the work to be performed (scope of services). For each additional required insurance, a corresponding certificate of insurance must be provided. Claims-made policies must have a retroactive date either prior to the effective date of the Contract or the beginning of the Contract work. Claims-made coverage must extend a minimum of twelve (12) months beyond completion of Contract work or end of current Contract, whichever is later. If coverage is cancelled or non-renewed, and not replaced with another claims made policy with a retroactive date prior to the Contract effective date, the Contractor must purchase extended reporting coverage for a minimum of twelve (12) months beyond completion of Contract work. Contractor shall maintain a policy limit of not less than one million dollars ($1,000,000) per incident, with a deductible or self-insured retention not to exceed *$2,500 unless approved by the County.

  • Other Insurance Policies No action, inaction or event has occurred and no state of facts exists or has existed that has resulted or will result in the exclusion from, denial of, or defense to coverage under any applicable special hazard insurance policy, PMI Policy or bankruptcy bond, irrespective of the cause of such failure of coverage. In connection with the placement of any such insurance, no commission, fee, or other compensation has been or will be received by Seller or by any officer, director, or employee of Seller or any designee of Seller or any corporation in which Seller or any officer, director, or employee had a financial interest at the time of placement of such insurance.

  • ADDITIONAL INSURED ENDORSEMENT AND PRIMARY AND NON-CONTRIBUTORY INSURANCE CLAUSE Supplier agrees to list Sourcewell and its Participating Entities, including their officers, agents, and employees, as an additional insured under the Supplier’s commercial general liability insurance policy with respect to liability arising out of activities, “operations,” or “work” performed by or on behalf of Supplier, and products and completed operations of Supplier. The policy provision(s) or endorsement(s) must further provide that coverage is primary and not excess over or contributory with any other valid, applicable, and collectible insurance or self-insurance in force for the additional insureds.

  • Other Insurance If requested by the Director, Contractor shall furnish adequate evidence of Social Security and Unemployment Compensation Insurance, to the extent applicable to Contractor’s operations under this Agreement.

  • Windstorm or hail This peril does not include loss to the property contained in a building caused by rain, snow, sleet, sand or dust unless the direct force of wind or hail damages the building causing an opening in a roof or wall and the rain, snow, sleet, sand or dust enters through this opening. This peril includes loss to watercraft and their trailers, furnishings, equipment, and outboard engines or motors, only while inside a fully enclosed building.

  • Errors and Omissions, Professional Liability or Malpractice Insurance Contractor may be required to carry errors and omissions, professional liability or malpractice insurance. All policies shall remain in force through the life of this Contract and shall be payable on a "per occurrence" basis unless County specifically consents to a "claims made" basis. The insurer shall supply County adequate proof of insurance and/or a certificate of insurance evidencing coverages and limits prior to commencement of work. Should any of the required insurance policies in this Contract be cancelled or non-renewed, it is the Contractor’s duty to notify the County immediately upon receipt of the notice of cancellation or non-renewal. If Contractor does not carry a required insurance coverage and/or does not meet the required limits, the coverage limits and deductibles shall be set forth on a waiver, Exhibit C, attached hereto. Failure to provide and maintain the insurance required by this Contract will constitute a material breach of this Contract. In addition to any other available remedies, County may suspend payment to the Contractor for any services provided during any time that insurance was not in effect and until such time as the Contractor provides adequate evidence that Contractor has obtained the required coverage.

  • Professional Indemnity Insurance A policy of insurance to cover claims made against the insured for: civil liability for breach of professional duty (whether owed in contract or otherwise); and unintentional breaches of third party intellectual property, by the Contractor or its subcontractors in carrying out the Contractor's Activities.

  • Third Party Liability For the purposes of the Contracts (Rights of Third Parties) Xxx 0000 this Agreement is not intended to, and does not, give any person who is not a party to it any right to enforce any of its provisions.

  • Deductibles and Self-Insurance Retentions Any deductibles or self-insured retentions must be declared to and approved by the City. The City may require the Consultant to provide proof of ability to pay losses and related investigation, claims administration and defense expenses within the deductible or self-insured retention. The deductible or self-insured retention may be satisfied by either the named insured or the City.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!