UNDERPAYMENT/PAYMENTS POST APPEALS Sample Clauses

UNDERPAYMENT/PAYMENTS POST APPEALS a. If the LME/PIHP determines that CONTRACTOR has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) days notice to the CONTRACTOR of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the CONTRACTOR. CONTRACTOR shall have thirty (30) days from date of such notification to appeal the determination of the LME/PIHP. The LME/PIHP shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims. b. Within thirty (30) days of the conclusion of any grievance, appeal or litigation that determines that LME/PIHP improperly failed to pay a claim or a portion of a claim to CONTRACTOR, the LME/PIHP shall remit the amount determined to be owed to CONTRACTOR.
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UNDERPAYMENT/PAYMENTS POST APPEALS. 4.10.1. If Sandhills Center determines that Practitioner has not been paid a claim or a portion of a claim that Sandhills Center determines should be allowed for any reason, Sandhills Center shall provide thirty (30) days’ notice to the Practitioner of the intent to pay the claims or portions of claims. Such notice of action shall identify the Member(s) name and date(s) of service in question, the specific determination made by Sandhills Center as to each claim, and the amount of payment due to the Practitioner. Practitioner shall have thirty (30) days from date of such notification to appeal the determination of Sandhills Center. Sandhills Center shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims. 4.10.2. Within thirty (30) days of the conclusion of any grievance, appeal or litigation that determines that Sandhills Center improperly failed to pay a claim or a portion of a claim to Practitioner, Sandhills Center shall remit the amount determined to be owed to Practitioner.
Sample 1
UNDERPAYMENT/PAYMENTS POST APPEALS. A. If the BH I/DD Tailored Plan determines that Contractor has not been paid a claim or a portion of a claim that the BH I/DD Tailored Plan determines should be allowed for any reason, the BH I/DD Tailored Plan shall provide notice to the Contractor of the intent to pay the claims or portions of claims. Such notice of action shall identify the Member name and dates of service in question, the specific determination made by the BH I/DD Tailored Plan as to each claim, and the amount of payment due to the Contractor. Contractor shall have thirty (30) days from date of such notification to appeal the determination of the BH I/DD Tailored Plan. The BH I/DD Tailored Plan shall make such payment upon notice of intent to pay claims or portions of claims. B. Upon the conclusion of any grievance, appeal or litigation that determines that BH I/DD Tailored Plan improperly failed to pay a claim or a portion of a claim to Contractor, the BH I/DD Tailored Plan shall remit the amount determined to be owed to Contractor.
Sample 1
UNDERPAYMENT/PAYMENTS POST APPEALS. If the LME/PIHP determines that CONTRACTOR has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) days notice to the CONTRACTOR of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the CONTRACTOR. CONTRACTOR shall have thirty (30) days from date of such notification to appeal the determination of the LME/PIHP. The LME/PIHP shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims. Within thirty (30) days of the conclusion of any grievance, appeal or litigation that determines that LME/PIHP improperly failed to pay a claim or a portion of a claim to CONTRACTOR, the LME/PIHP shall remit the amount determined to be owed to CONTRACTOR. REQUIRED APPENDICES/ATTACHMENTS: _____Appendix A Certification Regarding Environmental Tobacco Smoke _____Appendix B Certification Regarding Lobbying _____Appendix C Certification Regarding Drug-Free Workplace _____Appendix D Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion-Lower Tier Covered Transactions _____Appendix E Outcomes and Reporting Requirements _____Appendix F Mixed Services Payment Protocol _____Appendix G Provider Specialty Practice Information _____Attachment A Contracted Services and Qualified/Approved Sites _____Attachment B Provider Disclosure Form
Sample 1
UNDERPAYMENT/PAYMENTS POST APPEALS. If the LME/PIHP determines that LIP has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) days’ notice to the LIP of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the LIP. LIP shall have thirty (30) days from date of such notification to appeal the determination of the LME/PIHP. The LME/PIHP shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims.
Sample 1
UNDERPAYMENT/PAYMENTS POST APPEALS a. If the LME/PIHP determines that CONTRACTOR has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) days notice to the CONTRACTOR of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the CONTRACTOR. CONTRACTOR shall have thirty (30) days from date of such notification to appeal the determination of the LME/PIHP. The LME/PIHP shall make such payment within thirty (30) days of the date of the notice of intent to pay claims or portions of claims. b. Within thirty (30) days of the conclusion of any grievance, appeal or litigation that determines that LME/PIHP improperly failed to pay a claim or a portion of a claim to CONTRACTOR, the LME/PIHP shall remit the amount determined to be owed to CONTRACTOR. c. The party contracting with Trillium hereby certifies that (1) it is not on the Final Divestment List as created by the State Treasurer pursuant to N.C.G.S. 143-6A-4 and (2) in the performance of its obligations herein, it shall not subcontract with an entity that is identified on the Final Divestment List.
Sample 1
UNDERPAYMENT/PAYMENTS POST APPEALS a. If the LME/PIHP determines that Contractor has not been paid a claim or a portion of a claim that the LME/PIHP determines should be allowed for any reason, the LME/PIHP shall provide thirty (30) day notice to the Contractor of the intent to pay the claims or portions of claims. Such notice of action shall identify the Enrollee(s) name and date(s) of service in question, the specific determination made by the LME/PIHP as to each claim, and the amount of payment due to the Contractor. Contractor shall have thirty
Sample 1
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Related to UNDERPAYMENT/PAYMENTS POST APPEALS

  • Overpayments Contractor promptly shall refund to Purchaser the full amount of any erroneous payment or overpayment. Such refunds shall occur within thirty (30) calendar days of written notice to Contractor; Provided, however, that Purchaser shall have the right to elect to have either direct payments or written credit memos issued. If Contractor fails to make timely refunds of overpayment(s) (either directly or by credit memo), Contractor shall pay Purchaser interest at the rate of one percent (1%) per month on the amount overdue thirty (30) calendar days after notice to Contractor.

  • Late Payment Surcharge In the event of delay in payment of a Monthly Xxxx by Buyer beyond thirty (30) days of its Due Date, a Late Payment Surcharge shall be payable to the SPD at the rate of 1.25% per month on the outstanding amount calculated on a day to day basis subject to such late payment being duly received by Buyer under the PSA from the Buying Entity(ies). The Late Payment Surcharge shall be claimed by the SPD through the Supplementary Xxxx.

  • OVERPAYMENT OF PURCHASES OR UNDERPAYMENT OF FEES Without limiting any other remedy available to any Purchaser, Contractor shall (a) reimburse Purchasers for any overpayments inconsistent with the terms of this Contract or Purchase Orders placed thereunder, at a rate of 125% of any such overpayments, found as a result of the examination of Contractor’s records; and (b) reimburse Enterprise Services for any underpayment of vendor management fees, at a rate of 125% of such fees found as a result of the examination of Contractor’s records (e.g., if Contractor underpays the Vendor Management Fee by $500, Contractor would be required to pay to Enterprise Services $500 x 1.25 = $625); Provided, however, that, in the event Contractor timely discovers and corrects any Purchaser overpayment or Contractor underpayment of vendor management fees and does so prior to the initiation of any audit, Contractor shall be entitled to reimburse Purchaser or pay to Enterprise Services the actual amount of such Purchaser overpayment or such underpayment of vendor management fees.

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