Secondary Payor definition

Secondary Payor means all cases in which the Affected Product Recipient has another responsible payor including, but not limited to, the Medicare Program or any other third-party payor, that made primary payment in connection with the Affected Product Recipient's Covered Revision Surgery. This payment will be made as designated by the Settling Health Plan's legal counsel no later than sixty (60) days after Sulzer's receipt of the Revision Report. As to those claims where the▇▇ ▇▇ ▇▇ dispute, the Revision Report and any supplemental Revision Report will serve as Sulzer's payment instructions to the Trustee pursuant to a Sulzer app▇▇▇▇▇ ▇▇ird party payor settlement as provided in the Class Action Settlement.
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Examples of Secondary Payor in a sentence

  • If so, benefits to be paid under the individual contract, if any, will be reduced by the amount paid or the reasonable cash value of services provided under this Contract.] The following provisions explain how this Contract’s group health benefits interact with the benefits available under Medicare as Secondary Payor rules.

  • Settlement Program Claimants specifically assume any and all Liens arising under the Medicare Secondary Payor Act and its associated regulations (42 U.S.C. §1395y(b); 42 C.F.R. Part 411) and/or any statutory or common law reimbursement provisions (“Covered Laws”) for items and services furnished to Medicare Part A and Part B beneficiaries.

  • Group agrees that coordination of benefits, benefit determinations under the Medicare Secondary Payor rules, and Workers’ Compensation recoveries shall be conducted by Group in accordance with the procedures set forth in the Provider Manual.

  • Coordination of benefits, benefit determinations under the Medicare Secondary Payor rules, and Workers’ Compensation recoveries shall be conducted by Provider in accordance with the procedures set forth in the Provider Manual.

  • To the extent that the federal or state government, through Medicare, Medicaid, the Veterans Administration or any other agency or entity asserts a reimbursement right against the Client or against the Company, pursuant to that agency's or entity's rights under applicable law (for example, Medicare Secondary Payor rules), with respect to claims processed by the Company under this Contract, the Client shall be responsible for reimbursing any such amounts determined to be owed.

  • No expense under this paragraph may be paid from the Medicare Set Aside Share of the Trust Estate to the extent prohibited by the Medicare Secondary Payor Law.

  • Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (“MMSEA”), titled Medicare Secondary Payor, (hereinafter “Section 111”) mandates that, effective January 1, 2009, all group health plans or their representatives submit certain information to Center of Medicare & Medicaid Services.

  • To the extent that the federal or state government, through Medicare, Medicaid, the Veterans Administration, or any other agency or entity asserts a reimbursement right against the Plan Sponsor or against the Company, pursuant to that agency’s or entity’s rights under applicable law (for example, Medicare Secondary Payor rules), with respect to claims processed by the Company under this Agreement, the Plan Sponsor shall be responsible for reimbursing any such amounts determined to be owed.

  • No Success Subject Company nor any of their Representatives has engaged in any action or failed to act in any manner that would subject any Success Subject Company to liability under the Medicare Secondary Payor Provisions of Section 1862(b) of the Social Security Act, Section 5000 of the Code or the Health Insurance Portability and Accountability Act of 1996 and the rules and regulations promulgated thereunder.

  • No Greenbrook Company nor any of their Representatives has engaged in any action or failed to act in any manner that would subject any Greenbrook Company to liability under the Medicare Secondary Payor Provisions of Section 1862(b) of the Social Security Act, Section 5000 of the Code or the Health Insurance Portability and Accountability Act of 1996 and the rules and regulations promulgated thereunder.