Common use of Third Party Reimbursement Clause in Contracts

Third Party Reimbursement. a. Contractor will comply with N.C.G.S. §122C-146, which requires the LME/PIHP to make every reasonable effort to collect payments from third party payors. Each time an Enrollee receives services Contractor shall determine if the Enrollee has third party coverage that covers the service provided. b. Contractor is required to xxxx all applicable third party payors prior to billing the LME/PIHP. 1) Medicaid benefits payable through the LME/PIHP are secondary to benefits payable by a primary payer, including Medicare, even if the primary payer states that its benefits are secondary to Medicaid benefits or otherwise limits its payments to Medicaid enrollees. 2) The LME/PIHP makes secondary payments to supplement the primary payment if the primary payment is less than the lesser of the usual and customary charges for the service or the rate established by the LME/PIHP. 3) The LME/PIHP does not make a secondary payment if the Contractor is either obligated to accept, or voluntarily accepts, as full payment, a primary payment that is less than its charges. 4) If Contractor or Enrollee receives a reduced primary payment because of failure to file a proper claim with the primary payor, the LME/PIHP secondary payment may not exceed the amount that would have been payable if the primary payer had paid on the basis of a proper claim. 5) Contractor must inform the LME/PIHP that a reduced payment was made, and the amount that would have been paid if a proper claim had been filed. c. Contractor shall xxxx the LME/PIHP for third party co-pays and/or deductibles only as permitted by Controlling Authority.

Third Party Reimbursement. a. Contractor CONTRACTOR will comply with N.C.G.S. §122C-146, which requires the LME/PIHP to make every reasonable effort to collect payments from third party payors. Each time an Enrollee receives services Contractor CONTRACTOR shall determine if the Enrollee has third party coverage that covers the service provided. b. Contractor CONTRACTOR is required to xxxx bill all applicable third party payors prior to billing the LME/PIHP. 1) Medicaid benefits payable through the LME/PIHP are secondary to benefits payable by a primary payer, including Medicare, even if the primary payer states that its benefits are secondary to Medicaid benefits or otherwise limits its payments to Medicaid enrollees. 2) The LME/PIHP makes secondary payments to supplement the primary payment if the primary payment is less than the lesser of the usual and customary charges for the service or the rate established by the LME/PIHP. 3) The LME/PIHP does not make a secondary payment if the Contractor CONTRACTOR is either obligated to accept, or voluntarily accepts, as full payment, a primary payment that is less than its charges. 4) If Contractor CONTRACTOR or Enrollee receives a reduced primary payment because of failure to file a proper claim with the primary payor, the LME/PIHP secondary payment may not exceed the amount that would have been payable if the primary payer had paid on the basis of a proper claim. 5) Contractor CONTRACTOR must inform the LME/PIHP that a reduced payment was made, and the amount that would have been paid if a proper claim had been filed. c. Contractor CONTRACTOR shall xxxx bill the LME/PIHP for third party co-pays and/or deductibles only as permitted by Controlling Authority.

Third Party Reimbursement. a. Contractor LIP will comply with N.C.G.S. §122C-146, which requires the LME/PIHP to make every reasonable effort to collect payments from third party payors. Each time an Enrollee receives services Contractor services, LIP shall determine if the Enrollee has third party coverage that covers the service provided. b. Contractor LIP is required to xxxx all applicable third party payors prior to billing the LME/PIHP. 1) Medicaid benefits payable through the LME/PIHP are secondary to benefits payable by a primary payer, including Medicare, even if the primary payer states that its benefits are secondary to Medicaid benefits or otherwise limits its payments to Medicaid enrolleesEnrollees. 2) The LME/PIHP makes secondary payments to supplement the primary payment if the primary payment is less than the lesser of the usual and customary charges for the service or the rate established by the LME/PIHP. 3) The LME/PIHP does not make a secondary payment if the Contractor LIP is either obligated to accept, or voluntarily accepts, as full payment, a primary payment that is less than its charges. 4) If Contractor LIP or Enrollee receives a reduced primary payment because of failure to file a proper claim with the primary payor, the LME/PIHP secondary payment may not exceed the amount that would have been payable if the primary payer had paid on the basis of a proper claim. 5) Contractor LIP must inform the LME/PIHP that a reduced payment was made, and the amount that would have been paid if a proper claim had been filed. c. Contractor LIP shall xxxx the LME/PIHP for third party co-pays and/or deductibles only as permitted by Controlling Authority.

Third Party Reimbursement. a. Contractor will comply with N.C.G.S. §122C-146, which requires the LME/PIHP to make every reasonable effort to collect payments from third party payors. Each time an Enrollee receives services Contractor shall determine if the Enrollee has third party coverage that covers the service provided. b. Contractor is required to xxxx bill all applicable third party payors prior to billing the LME/PIHP. 1) Medicaid benefits payable through the LME/PIHP are secondary to benefits payable by a primary payer, including Medicare, even if the primary payer states that its benefits are secondary to Medicaid benefits or otherwise limits its payments to Medicaid enrolleesbeneficiaries. 2) The LME/PIHP makes secondary payments to supplement the primary payment if the primary payment is less than the lesser of the usual and customary charges for the service or the rate established by the LME/PIHP. 3) The LME/PIHP does not make a secondary payment if the Contractor is either obligated to accept, or voluntarily accepts, as full payment, a primary payment that is less than its charges. 4) If Contractor or Enrollee receives a reduced primary payment because of failure to file a proper claim with the primary payor, the LME/PIHP secondary payment may not exceed the amount that would have been payable if the primary payer had paid on the basis of a proper claim. 5) Contractor must inform the LME/PIHP that a reduced payment was made, and the amount that would have been paid if a proper claim had been filed. c. Contractor shall xxxx bill the LME/LME/ PIHP for third party co-pays and/or deductibles only as permitted by Controlling Authority.