Verify Member Eligibility Sample Clauses

Verify Member Eligibility. Prior to furnishing any Covered Prescription Service, PHARMACY shall verify that the individual receiving such Covered Prescription Service is an eligible Member. Such verification shall be performed by the PHARMACY through point-of-service (“POS”) data communication between the PHARMACY and Claims Processor. If any PHARMACY is unable to confirm a Member’s eligibility by POS communication, then the PHARMACY shall call SOUTHERN SCRIPTS’ pharmacy help desk (or equivalent) for verification.
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Verify Member Eligibility. Determine the Medical Necessity of medical transportation services in accordance with the Medical Necessity standards set forth in the applicable Administrative Manual. Any claim that would be denied on the basis of Medical Necessity shall be referred to the Contracted Health Plan prior to denial. Except as otherwise provided in the applicable Administrative Manual, (a) the Contracted Health Plan, or its designee, shall be solely responsible for notifying the Member of the denial of any claim; and (b) CONTRACTOR shall not contact the Member with respect to any denial of claims. If the Contracted Health Plan approves the claim, it shall notify CONTRACTOR of the approval, and CONTRACTOR shall promptly pay the claim. Notwithstanding the foregoing, if Customer's referral authorization is included in the claims submission, then the Medical Necessity of the claims will be deemed to be determined, and further review will not be required.

Related to Verify Member Eligibility

  • Member Eligibility Verify Member eligibility contemporaneous with the rendering of services. BCBS will provide systems and/or methods for verification of eligibility and benefit coverage for Members. This is furnished as a service and not as a guarantee of payment;

  • Membership Eligibility To join the Credit Union, you must meet the membership requirements, including purchase and maintenance of the minimum required share(s) (“membership share”) as set forth in the Credit Union’s bylaws. You authorize us to check your account, credit and employment history, and obtain reports from third parties, including credit reporting agencies, to verify your eligibility for the accounts and services you request.

  • Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.

  • Contribution Eligibility You are eligible to make a regular contribution to your Xxxx XXX, regardless of your age, if you have compensation and your MAGI is below the maximum threshold. Your Xxxx XXX contribution is not limited by your participation in an employer-sponsored retirement plan, other than a Traditional IRA.

  • Employee Eligibility For purposes of this section, “eligible employee” shall be defined by the Public Employees’ Medical and Hospital Care Act.

  • Dependent Eligibility For all programs covered in this article, eligible dependents are an employee’s lawful spouse or domestic partner (as defined by Section 297 of the California Family Code), and unmarried children (natural, step, adopted, legal guardianship, and/or xxxxxx) of the employee or domestic partner, who are qualified IRS dependents of the employee or domestic partner, up to twenty-three (23) years of age. Disabled dependents may be able to continue coverage beyond the limiting age if the disability occurred while the dependent was covered under a County-sponsored medical plan or prior to the dependent’s 19th birthday, and is certified by a licensed physician.

  • Student Eligibility The LEA and POSTSECONDARY INSTITUTION shall qualify and advise candidates for dual credit from the pool of eligible high school students. A candidate for dual credit is eligible for consideration for fall, spring, and summer semesters if he or she: a. is enrolled during the fall and spring in a LEA in one-half or more of the minimum course requirements approved by PED for public school students under its jurisdiction or by being in physical attendance at a bureau of Indian education-funded high school at least three documented contact hours per day pursuant to 25 CFR 39.211(c); b. obtains permission from the LEA representative (in consultation with the student’s individualized education program team, as needed), the student’s parent or guardian if the student is under 18 years old, and POSTSECONDARY INSTITUTION representative prior to enrolling in a dual credit course; and c. meets POSTSECONDARY INSTITUTION requirements to enroll as a dual credit student.

  • Funding Eligibility Contractor understands, acknowledges, and agrees that, pursuant to Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code, except as exempted under that Chapter, HHSC cannot contract with an abortion provider or an affiliate of an abortion provider. Contractor certifies that it is not ineligible to contract with HHSC under the terms of Chapter 2272 (eff. Sept. 1, 2021, Ch. 2273) of the Texas Government Code.

  • Wire Transfer Eligibility Section 11.24

  • Special Eligibility The following employees also receive an Employer Contribution:

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