Timely Payment Requirement Sample Clauses

Timely Payment Requirement. The MCO must agree to make timely claims payments to both its contracted and non-contracted providers. A claim is defined as a bill for services, a line item of service, or all services for one recipient within a bill. A clean claim is defined as one that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. The MCO must pay all clean in-network provider claims for covered services within thirty (30) calendar days of receipt, except to the extent the provider has agreed to later payment in writing. The MCO must pay all electronic out-of-network clean claims within thirty (30) days and all paper out-of-network clean claims within forty (40) days from the date of receipt, except to the extent the provider has agreed to later payment in writing. The MCO must agree to specify the date of receipt as the date the MCO receives the claim, as indicated by its date stamp (including electronic date stamp) on the claim, and date of payment as the date of the check release or other form of payment release to the provider. The MCO must pay in-network providers interest at seven (7) percent per annum, calculated daily for the full period in which the clean claim remains unpaid beyond the thirty (30) day clean claims payment deadline. Interest owed to the provider must be paid on the same date as the claim. The interest paid to the providers will not be reported as a part of the MCO encounter data. This provision does not apply to payments made due to a rate change per Article III, §2.7.9.
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Timely Payment Requirement. The MCO must agree to make timely claims payments to both its contracted and non-contracted providers. A claim is defined as a bill for services, a line item of service, or all services for one (1) enrollee within a bill. A clean claim is defined as one that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. The MCO must pay all clean electronic and paper claims for covered services from both in- network and out-of-network providers within thirty (30) calendar days of receipt, except to the extent the provider has agreed to later payment in writing. The MCO must agree to specify the date of receipt as the date the MCO receives the claim, as indicated by its date stamp (including electronic date stamp) on the claim, and date of payment as the date of the check release or other form of payment release to the provider. The MCO must submit monthly a claim aging report that provides information on all overdue clean claims for both in-network and out-of-network providers as noted in Appendix D. The MCO must pay both in-network and out-of-network providers interest at eighteen percent (18%) per annum, calculated daily for the full period in which the clean claim remains unpaid beyond the thirty (30) day clean claims payment deadline. Interest owed to the provider must be paid on the same date as the claim. The interest paid to the providers will not be reported as a part of the MCO encounter data. This provision does not apply to payments made due to a rate change per Article III, Section 2.7.9. As related to the sanction outlined in Appendix F, the MCO must meet a ninety percent (90%) threshold for timely claims payment (90% of total clean claims within 30 days), which aligns with 42 CFR §447.45(d)(2) for fee-for-service Medicaid.
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Timely Payment Requirement. The MCO must agree to make timely claims payments to both its contracted and non-contracted providers. A claim is defined as a bill for services, a line item of service, or all services for one enrollee within a bill. A clean claim is defined as one that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity.
Sample 1Sample 2
Timely Payment Requirement. The MCO must agree to make timely claims payments to both its contracted and non-contracted providers. A claim is defined as a xxxx for services, a line item of service, or all services for one recipient within a xxxx. A clean claim is defined as one that can be processed without obtaining additional information from the provider of the service or from a third party. It does not include a claim from a provider who is under investigation for fraud or abuse, or a claim under review for medical necessity. The MCO will not be held to this requirement should BMS be delayed in its payment to the MCO by a period of more than 15 days. In such a situation, the MCO may delay payment to contracted and non-contracted providers by a period not to exceed the delay in payment from BMS. The MCO must provide payment to affiliated health care providers for items and services covered under this contract on a timely basis, consistent with the claims payment procedures described in section 1902(a)(37)(A) of the Social Security Act and the implementing Federal regulation at 42 CFR 447.45, outlined above, unless the health care provider and organization agree to an alternative payment schedule. The MCO must make timely payments to out-of-network providers for medically necessary, covered services. The MCO must pay at least 90 percent of all clean claims (claims that pass all edits required for payments by the MCO) from subcontractors for covered services within 30 calendar days of receipt and pay at least 99 percent of all clean claims within 90 calendar days of receipt, except to the extent subcontractors have agreed to later payment. The MCO must pay all other claims, except those from providers under investigation for fraud and abuse, within 12 months of the date of receipt. The MCO must agree to specify the date of receipt as the date the agency receives the claim, as indicated by its date stamp on the claim, and date of payment as the date of the check or other form of payment.
Sample 1

Related to Timely Payment Requirement

  • Payment Requirements ‌ A. Contract Amount: It is expressly agreed and understood that the total amount to be paid by County under this Contract shall not exceed the total County funding as set forth in Attachment B-Payment/Compensation to Subrecipient attached hereto and incorporated herein by reference. B. County will reclaim any unused balance of funds for reallocation to other County approved projects.

  • Enrollment Requirements You must maintain with Blue Cross and Blue Shield a current and updated listing of covered employees. You will be responsible for all claims costs and expenses associated with failure to maintain an accurate and current listing with Blue Cross and Blue Shield, unless such claims costs and expenses are due to an error on Blue Cross and Blue Shield’s part. In order to maintain health care coverage with Blue Cross and Blue Shield, an employee must meet the written eligibility requirements (such as length of service, active employment and number of hours worked) you impose as long as they do not conflict with Blue Cross and Blue Shield’s eligibility requirements. An eligible employee as defined by Blue Cross and Blue Shield means: • A permanent full-time employee regularly working 30 hours or more each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A permanent part-time employee regularly working at least 20 hours but less than 30 hours each week at the employer’s usual place(s) of business and who is paid a salary or wage in accordance with state and federal wage requirements; or • A disabled permanent full-time or part-time employee who is actively working despite the disability (including one who is engaged in a trial work period) and a disabled employee who is not actively working but whom the employer treats as an employee; or • A former employee (or a former covered dependent of the employee of the group) who qualifies for continued group coverage under federal or state law, but only if the employer maintains Blue Cross and Blue Shield group coverage for permanent full-time employees as defined in (a) above; or • A retired employee of the employer. Newly hired employees who are eligible for group benefits can enroll in the benefits plan according to your eligibility requirements for coverage, provided that your requirements comply with Blue Cross and Blue Shield’s eligibility and enrollment requirements. The effective date of an eligible employee’s (or his or her dependent’s) membership in the benefits plan may be the Member’s initial eligibility date or your subsequent anniversary/renewal date, as long as: (a) Blue Cross and Blue Shield receives your written notice no later than 30 days after the Member’s enrollment notification period applicable to membership modifications (as described in the Subscriber Certificate for your benefits plan); and (b) you pay the applicable premium charges.

  • Agreement Requirements This agreement will be issued to cover the Janitorial Service requirements for all State Agencies and shall be accessible to any School District, Political Subdivision, or Volunteer Fire Company.

  • CONTRACT REQUIREMENTS A. Project area boundaries are marked with two blue paint slashes and block boundaries are designated with one blue paint slash. B. All blocks are accessible by foot only. Xxxxxx’x Creek must be crossed on foot from the PGC railroad grade. C. Block 1, All trees 1” DBH and over, except for red and blue paint marked trees are to be cut. All conifers are reserved. Block 1 will be cut during the dormant season; October 15 through March 15. D. Block 2, All American beech, sweet birch, aspen, stripped maple, and ironwood 1” DBH and greater will be cut. All yellow marked trees will be cut. Block 2 will be cut during the dormant season; October 15 through March 15. E. Block 3, All trees 1” DBH and over, except for red and blue paint marked trees are to be cut. All conifers are reserved. Block 3 will be cut during the dormant season; October 15 through March 15. F. All employees must be able to identify species. G. Usable material may not be removed from site. X. Xxxxx material felled with clean cuts must have stumps that are parallel to the ground surface and shall not exceed six (6) inches in height measured on the side next to the highest ground or the diameter of the xxxxx, whichever is smaller, except when in the opinion of the Field Contract Coordinator, said height is impractical. I. Cut trees must be removed from trails, roads, tail drains, streams, and utility rights-of- way. J. All trees shall be felled so tops do not pile on one another but lie singly on the ground. K. Slash shall be lopped to no higher than 4’ and pulled apart as directed by the Regional Forester. L. Operator shall exercise care and caution in all operations to prevent damage to all trees not specified for treatment. M. All tops must be pulled back 25 feet from the State Game Land boundary, (blazed & painted white), all roads, parking lots, herbaceous openings, utility Right of Ways and deer exclosures. Tops, branches, and slash will be removed from all ponds, lakes, and streams. N. Damage to trails, roads, streams, or utility rights-of-way caused by the Operator’s equipment must be repaired by the Operator at their expense. O. Any trash resulting from the Operator’s operations must be removed from the area and properly disposed. P. The Operator shall not block any roads or trails in the area during performance of this contract. The Operator shall not in any way hinder the progress of any Timber Sale Contracts in these areas. Q. All labor, equipment, tools, etc., needed to complete contracted projects are to be provided by the Operator. R. Timber Damages – when in the opinion of Field Contract Coordinator, damage to the residual stand becomes excessive, the Operator shall pay the Commission a fair base current value determined by the Field Contract Coordinator per unit of volume. If this value for damage due to Operator’s carelessness or negligence is less than $10.00 per tree, then a minimum charge of $10.00 per tree will be made whether the tree is commercial, non-commercial, merchantable, or non-merchantable.

  • W-9 Requirement Alongside a signed copy of this Agreement, Grantee will provide Florida Housing with a properly completed Internal Revenue Service (“IRS”) Form W-9. The purpose of the W-9 form is to document the SS# or FEIN# per the IRS. Note: W-9s submitted for any other entity name other than the Grantee’s will not be accepted.

  • Employment Requirement If the Employer's Plan is a Standardized Plan, a Participant who, during a particular Plan Year, completes the accrual requirements of Adoption Agreement Section 3.06 will share in the allocation of Employer contributions for that Plan Year without regard to whether he is employed by the Employer on the Accounting Date of that Plan Year. If the Employer's Plan is a Nonstandardized Plan, the Employer must specify in its Adoption Agreement whether the Participant will accrue a benefit if he is not employed by the Employer on the Accounting Date of the Plan Year. If the Employer's Plan is a money purchase plan or a target benefit plan, whether Nonstandardized or Standardized, the Plan conditions benefit accrual on employment with the Employer on the last day of the Plan Year for the Plan Year in which the Employer terminates the Plan.

  • Minimum Purchase Requirements Distributor shall make the minimum annual purchase of Products established in Exhibit B, unless the Agreement has become coexclusive. In the period within the fixed term and extension, if applicable, of the Agreement under Section 10(a) subsequent to [ * ], the parties shall meet in San Francisco at least [ * ] prior to the beginning of each of respective year to discuss market conditions and appropriate minimum purchases for such year. In the event that the parties fail to agree on an appropriate minimum any year subsequent to [ * ], the minimum annual purchase requirement for such year shall be calculated increasing or decreasing (as the case may be) the minimum purchase requirement for the preceding year in proportion to the increase or decrease in the [ * ] (based on data from mutually acceptable data provider) of the applicable product in the Territory. In the event Supplier is unable to deliver Products ordered by Distributor in an amount consistent with the most recent forecast, then the minimum annual purchase requirement shall be reduced by the quantity of Products that Supplier is unable to deliver when requested. In the event Distributor fails in any year (a “Shortfall Year”) to make the annual minimum purchase of Agreement Products required by Exhibit B, Supplier shall have the right to give Distributor written notice of default, and if such failure to make the minimum purchase is not cured (through the purchase of an amount of Agreement Product equal to the entire shortfall in the Shortfall Year, which amount shall not be counted towards any minimum purchase requirements for the year of purchase) within [ * ] of receipt of the notice, then Supplier shall have the right, in Supplier’s sole discretion and as Supplier’s sole remedy for Distributor’s failure to meet the minimum purchase requirements hereunder, either to convert the appointment of Distributor from exclusive to non-exclusive or to terminate this Agreement. In the event of either conversion to non-exclusive or termination of this Agreement pursuant to this Section 3(e), the Supplier shall pay Distributor a conversion fee equal to [ * ], and Distributor shall transfer all Regulatory Approvals relating to BMS or DES in the Territory to Supplier.

  • Subcontract Requirements As required by Section 6.22(e)(5) of the Administrative Code, Contractor shall insert in every subcontract or other arrangement, which it may make for the performance of Covered Services under this Agreement, a provision that said subcontractor shall pay to all persons performing labor in connection with Covered Services under said subcontract or other arrangement not less than the highest general prevailing rate of wages as fixed and determined by the Board of Supervisors for such labor or services.

  • Release Requirement Notwithstanding any provision herein to the contrary, except as otherwise determined by the Company, in order for the Grantee to receive Shares pursuant to the settlement of Vested RSUs under Section 6(a), (b), (c), (d) or (e) above, the Grantee (or the representative of his or her estate) must execute and deliver to the Company a general release and waiver of claims against the Company, its Subsidiaries and their directors, officers, employees, shareholders and other affiliates in a form that is satisfactory to the Company (the “Release”). The Release must become effective and irrevocable under applicable law no later than 60 days following the date of the Grantee’s death, termination of employment or transfer of position, as applicable.

  • Withholding Requirements In the event that any jurisdiction imposes any withholding or other tax on any payment made by Xxxxxxx Mac (or its agent, the Exchange Administrator, or any other person potentially required to withhold) with respect to a Note, Xxxxxxx Mac (or its agent, the Exchange Administrator, or such other person) will deduct the amount required to be withheld from such payment, and Xxxxxxx Mac (or its agent, the Exchange Administrator, or such other person) will not be required to pay additional interest or other amounts, or redeem or repay the Notes prior to the Maturity Date, as a result.

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