Retrospective review means a review of medical necessity conducted after services have been provided to a patient, but does not include the review of a claim that is limited to an evaluation of reimbursement levels, veracity of documentation, accuracy of coding, or adjudication for payment.
Prospective review means utilization review conducted prior to an admission or a course of treatment.
Rebates means rebates, price reductions and administrative fees and related adjustments charged by or payments to state Medicaid and other federal, state and local governmental programs and their participants, and by health plans, insurance companies, Medicare Part D prescription drug plans, pharmacy benefits managers, mail service pharmacies, long term care providers, specialty pharmacies and other health care providers based upon the utilization and sales of the Product, and service, administrative and inventory management fees due to wholesalers, distributors and group purchasing organizations based on sales of the Product (in each case, other than chargeback claims).
Medicare cost report means CMS-2552-10, the cost report for electronic filing of
Administrative Review means any decision making process of the director requested by a party aggrieved with an action taken under these rules except the hearing process described in OAR 436-001.
Adaptive Reuse means a proposed development that will be repurposed from what it was originally built and designed for. Except where stated otherwise, rehabilitation requirements in Threshold apply to Adaptive Reuse projects.
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.
Rebate shall have the same meaning as ascribed thereto in Article 10.3.4 of this Agreement;
Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.
Enrollee point-of-service cost-sharing or "cost-sharing" means amounts paid to health carriers directly providing services, health care providers, or health care facilities by enrollees and may include copayments, coinsurance, or deductibles.
Insurance Contracts means all contracts and policies of insurance and re-insurance maintained or required to be maintained by or on behalf of any Grantor under the Loan Documents.
Insurance Contract means a contract (other than an Annuity Contract) under which the issuer agrees to pay an amount upon the occurrence of a specified contingency involving mortality, morbidity, accident, liability, or property risk.
R&W Policy means those certain buyer-side representations and warranties insurance policies purchased by Buyer in connection with this Agreement.
Cost Reimbursement means a contract which provides for a fee other than a fee based on a percentage of cost and under which a contractor is reimbursed for costs which are allowable and allocable in accordance with the contract terms.
Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.
Premium tax means a tax paid by insurance companies to provincial and territorial governments calculated as a percentage of gross premiums written.
Capitation means the reimbursement arrangement in which a fixed rate of payment per Enrollee per month is made to the Contractor for the performance of all of the Contractor’s duties and obligations pursuant to this Contract.
Extra Premium means an additional amount charged by Us, as per Our Underwriting Policy, which is determined on the basis of disclosures made by You in the Proposal Form or any other information received by Us including medical examination report of the Life Insured.
Chargebacks means all chargebacks, credits, reimbursements and related adjustments, in each case other than Rebates, that are charged by wholesalers, group purchasing organizations, managed care entities, distributors and other selling agents.
Paid sick leave – means paid leave under the Emergency Paid Sick Leave Act.
LPMI Policy A policy of primary mortgage guaranty insurance issued by a LPMI Insurer pursuant to which the related premium is to be paid from payments of interest made by the Mortgagor.
Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.
Premiums means premiums, considerations, deposits and similar receipts with respect to the Policies or Post-Closing Policies.
child tax credit means a child tax credit under section 8 of the Tax Credits Act 2002;
Cost-reimbursement contract means a contract under which a contractor is
Administrative Requirement means any required notice, filing or other similar administrative requirements (other than any requirement for Consent or any Eligibility Requirements) for the Transfer of any Appointment to the applicable Purchaser as set forth in the related Corporate Trust Contract.