Responsible payor definition

Responsible payor means a person who:
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Responsible payor means an entity liable for making benefit payments under a Benefit Contract, or an entity with a fully or partially self-funded Benefit Plan administered by HMC, which entity is financially responsible for paying Benefits for Covered Services rendered to Members. Responsible Payors may be health maintenance organizations (HMOs), Preferred Provider Organizations (PPOs), insurers, employers, self-funded employers, self-funded trust funds or other entities.
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Examples of Responsible payor in a sentence

  • Further, Contracted Provider shall look solely to HMC or Responsible Payor, as appropriate, for such reimbursement and shall not seek compensation from Members, except as set forth in Section 3.4 of this Agreement.

  • Visits beyond the specified time period authorized shall require additional authorization from HMC, Responsible Payor, or the selected Utilization Review entity.

  • In the event Contracted Provider does not agree with a denial of payment determination made by HMC or a Responsible Payor, an appeal may be filed with HMC or the Responsible Payor, as appropriate.

  • HMC or Responsible Payor, as appropriate, shall review such appeal in accordance with the applicable appeal procedures of the program.

  • HMC or Responsible Payor shall pay Contracted Provider compensation pursuant to the provisions set forth in Exhibit 1, Schedule of Payments.

  • Contracted Provider shall seek payment from HMC or Responsible Payor, as appropriate, only for the provision of Covered Services.

  • Further, the Utilization Review and quality assurance Procedures of HMC or Responsible Payor shall not diminish Contracted Provider’s obligation to render Covered Services consistent with the applicable standard of care.

Related to Responsible payor

  • Responsible Party means a public or private body or any other person which, alone or in conjunction with others, determines the purpose of and means for processing personal information, as defined in POPI.

  • Responsible Parties means all Retailers and Customers, including Transmission Load Customers, Distribution Load Customers, DG Customers, MG Customers or agents of the foregoing;

  • Responsible adult means a parent, guardian or other adult specifically authorized by law or authorized by a parent or guardian to have custody or control of a minor.

  • Responsible Person means any person other than the registered owner of an immovable property who is legally responsible for the payment of municipal service charges.

  • Responsible public entity means a public entity that has the power to develop or operate the applicable qualifying project.

  • Responsible Employee means an Employee (including a contract, temporary, or leased Employee) of the Health FSA Component or of the Employer whose duties (1) require that the Employee have access to PHI for purposes of Payment or Health Care Operations; or (2) make it likely that the Employee will receive or have access to PHI. Persons designated as Responsible Employees are described in Section 10.03. A Responsible Employee shall also include any other Employee (other than a designated Responsible Employee) who creates or receives PHI on behalf of a Health FSA Component, even though the Employee’s duties do not (or are not expected to) include creating or receiving PHI. Responsible Employees are within the Employer’s HIPAA firewall when they perform Health FSA Component functions.

  • Responsible agency means a public agency, which proposes to carry out or approve a project, for which [a] Lead Agency is preparing or has prepared an EIR or Negative Declaration. For the purposes of CEQA, the term “responsible agency” includes all public agencies other than the Lead Agency, which have discretionary approval power over the project. (Section 15381)

  • Responsible individual means an individual who is employed by a licensee and has principal managerial authority over the provision of money services by the licensee in this state.

  • Responsible Authority means any of the following: -

  • Responsible charge means direct control and personal supervision of engineering or surveying work.

  • Responsible administrative authority means, with respect to a structured settlement, any government authority vested by law with exclusive jurisdiction over the settled claim resolved by the structured settlement.

  • Responsible Contractor means a Contractor that has the capability in all material respects to perform the specifications of the Contract. In determining whether a Contractor is a Responsible Contractor, the Agency may consider various factors including, but not limited to, the Contractor’s competence and qualifications to provide the goods or services requested, the Contractor’s integrity and reliability, the past performance of the Contractor and the best interest of the Agency and the State.

  • Responsible Entity means Pendal Fund Services Limited ABN 13 161 249 332, AFSL 431426;

  • Responsible Respondent means a Respondent that has the capability in all material respects to perform the scope of work and specifications of the Contract. In determining whether a Respondent is a Responsible Respondent, the Agency may consider various factors including, but not limited to, the Respondent’s competence and qualifications to provide the goods or services requested, the Respondent’s integrity and reliability, the past performance of the Respondent and the best interest of the Agency and the State.

  • Responsible official means one of the following:

  • Responsible Offeror means an Offeror who submits a responsive proposal and who has furnished, when required, information and data to prove that his financial resources, production or service facilities, personnel, service reputation and experience are adequate to make satisfactory delivery of the services, or items of tangible personal property described in the proposal.

  • Third Party Payor means any governmental entity, insurance company, health maintenance organization, professional provider organization or similar entity that is obligated to make payments on any Account.

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Policy Grievance shall be signed by a xxxxxxx or a Union representative or, in the case of an Employer's policy grievance, by the Employer or its representative.

  • Contractor Related Parties means any affliates of the Contractor and the Contractor's executive officers, Pennsylvania officers and directors, or owners of 5 percent or more interest in the Contractor.