Member eligibility file definition

Member eligibility file means a data file containing demographic information for each individual member eligible for medical benefits, for one or more days of coverage at any time during the reporting month.
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Member eligibility file means a data file composed of demographic information for each individual Member eligible for medical or pharmacy benefits as specified in the RIAPCD Technical Specification Manual, for one or more days of coverage at any time during the reporting month.
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Member eligibility file means a data file composed of demographic information for each individual Member eligible for medical or pharmacy benefits as specified in the RIAPCD Technical Specification Manual, for one
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Examples of Member eligibility file in a sentence

  • IEHP utilizes the monthly Member eligibility file sent by Department of Health Care Services (DHCS) on information regarding the “Other Health Coverage” for the Medi- Cal Medicare Members.B. A Member is legally obligated to report information about Other Health Coverage.C. Members or other payers have up to thirty-six (36) months from the date on which the prescription for a covered Part D drug was filled to seek reimbursement from IEHP.

  • If a Member requests a change from one dental plan to another, the change will be prospective, and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.(c) HHSC Enrollment Broker enrolls and disenrolls Members from dental plans.

  • If a Member requests a change, the change will be prospective, and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.(b) In cases where a Member loses Medicaid eligibility, if Medicaid eligibility is re-instated or re-established within 6 months from the date of loss, HHSC will retroactively restore a Member's managed care enrollment to avoid a gap in coverage.

  • If a Member requests a change from one dental plan to another, the change will be prospective and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.(c) HHSC or the CHIP Administrative Services Contractor enrolls and disenrolls Members from dental plans.

  • If a Member requests a change, the change will be prospective and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.

  • If a Member requests a change, the change will be prospective and the effective date will be the first day of the month in which the Member appears on the Member eligibility file for the receiving dental plan.(b) In cases where a Member loses Medicaid eligibility, if Medicaid eligibility is re-instated or re- established within six months from the date of loss, HHSC will retroactively restore a Member's managed care enrollment to avoid a gap in coverage.

  • CCHP had to reconcile numerous HHSC Member eligibility file errors, faced initial resistance and no shows from some families, complied with HHSC’s request to not cause undue stress by aggressive pursuit to speak or meet with Members/LARs when they were hesitant to do so, and adjusted to HHSC changes in the prioritization of Members for early contact and assessment.

  • PIHP will provide Administrator with a monthly electronic Member eligibility file, full build and daily updates thereto, in a manner and using processes mutually agreed upon by the parties.

  • Member eligibility file" means a data file containing demographic information for each individual member eligible for medical, pharmacy, or dental benefits for one or more days of coverage at any time during the reporting month as well as any retrospective updates that correspond to previously submitted eligibility data.

  • If ESI must create or modify a Member eligibility file by manually entering employee data or if the format is inconsistent with ESI’s standard requirements, there will be a $1.00 per Member implementation fee.


More Definitions of Member eligibility file

Member eligibility file means a data file con- taining demographic information for each individual member eligible for medical or pharmacy benefits for one or more days of coverage at any time during the reporting month.
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Member eligibility file means a data file that contains demographic information for each individual member eligible for medical or pharmacy benefits for one or more days of coverage at any time during the reporting period.
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Member eligibility file means a data file containing demographic information for each individual member eligible for medical, pharmacy, or dental benefits for one or more days of coverage at any time during the reporting month as well as any retrospective updates that correspond to previously submitted eligibility data. [It should include]The term also includes benefits[,] attributed and associated effective periods.
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Member eligibility file means a data file containing
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Related to Member eligibility file

  • Retirement Eligibility means attainment of age 60 and completion of at least five (5) years of continuous service with the Company.

  • Eligibility Waiting Period means the continuous length of time you must be in Active Employment in an eligible class to reach your Eligibility Date.

  • Eligibility Service of an employee means the period or periods of service credited to him under the provisions of Article II for purposes of determining his eligibility to participate in the Plan as may be required under Article III or Article VI.

  • Eligibility and selection criteria means criteria for determining:

  • Eligibility Date means, with respect to each Borrower and Guarantor and each Swap, the date on which this Agreement or any Other Document becomes effective with respect to such Swap (for the avoidance of doubt, the Eligibility Date shall be the Effective Date of such Swap if this Agreement or any Other Document is then in effect with respect to such Borrower or Guarantor, and otherwise it shall be the Effective Date of this Agreement and/or such Other Document(s) to which such Borrower or Guarantor is a party).

  • Eligibility means the decision as to whether an individual qualifies, under financial and nonfinancial requirements, to receive program benefits.

  • Eligibility Conditions means the eligibility conditions specified in the Act and the Rules including all the eligibilityconditions listed in Clause [5] of the Tender Document.

  • Net Benefits Test means a calculation to determine whether the benefits of a reduction in price resulting from the dispatch of Economic Load Response exceeds the cost to other loads resulting from the billing unit effects of the load reduction, as specified in Operating Agreement, Schedule 1, section 3.3A.4 and the parallel provisions of Tariff, Attachment K-Appendix, section 3.3A.4. Net Cost of New Entry:

  • completed year of service means continuous service for one year;

  • Eligibility Determination means an approval or denial of eligibility and a renewal or termination of eligibility as set forth in OAR 410-200-0015;¶

  • Retirement Eligible means that the Participant has either attained age 55 and completed ten (10) years of Service as an Employee or attained age 60 and completed five (5) years of Service as an Employee.

  • DWAC Eligible means that (a) Borrower’s Common Stock is eligible at DTC for full services pursuant to DTC’s operational arrangements, including without limitation transfer through DTC’s DWAC system; (b) Borrower has been approved (without revocation) by DTC’s underwriting department; (c) Borrower’s transfer agent is approved as an agent in the DTC/FAST Program; (d) the Conversion Shares are otherwise eligible for delivery via DWAC; and (e) Borrower’s transfer agent does not have a policy prohibiting or limiting delivery of the Conversion Shares via DWAC.

  • Eligibility Requirements means, with respect to any Person, that such Person (i) has total assets (in name or under management) in excess of $600,000,000 and (except with respect to a pension advisory firm or similar fiduciary) capital/statutory surplus or shareholder’s equity of $250,000,000 and (ii) is regularly engaged in the business of making or owning commercial real estate loans or operating commercial mortgage properties.

  • Basic Plan means as to any Member or Vested Former Member the defined benefit pension plan of the Company or an Affiliated Employer intended to meet the requirements of Code Section 401(a) pursuant to which retirement benefits are payable to such Member or Vested Former Member or to the Surviving Spouse or designated beneficiary of a deceased Member or Vested Former Member.