Third Party Recovery definition

Third Party Recovery. (TPR) means the recovery of payments on behalf of a Member by HHSC or the MCO from an individual or entity with the legal responsibility to pay for the Covered Services. Transfer means the movement of the Member from one (1) Acute Care Hospital or Long Term Care Hospital/facility and readmission to another Acute Care Hospital or Long Term Care Hospital/facility within 24 hours for continued treatment. Transition Phase includes all activities the MCO is required to perform between the Contract Effective Date and the Operational Start Date for an MCO Program and all or part of a Service Area. Turnover Phase includes all activities the MCO is required to perform in order to close out the Contract and/or transition Contract activities and operations to HHSC or a subsequent contractor. Turnover Plan means the written plan developed by MCO, approved by HHSC, to be employed during the Turnover Phase. Uniform Managed Care Manual (UMCM) means the manual published by or on behalf of HHSC that contains policies and procedures required of all MCOs participating in the HHSC Programs. The UMCM, as amended or modified, is incorporated by reference into the Contract. URAC /American Accreditation Health Care Commission means the independent organization that accredits Utilization Review functions and offers a variety of other accreditation and certification programs for health care organizations. Urban County means any county with 50,000 or more residents as reported by the Texas Association of Counties at: xxxx://xxx.xxxxxx.xxx/. Urgent Behavioral Health Situation means a behavioral health condition that requires attention and assessment within 24 hours but which does not place the Member in immediate danger to himself or herself or others and the Member is able to cooperate with treatment. Urgent Condition means a health condition including an Urgent Behavioral Health Situation that is not an emergency but is severe or painful enough to cause a prudent layperson, possessing the average knowledge of medicine, to believe that his or her condition requires medical treatment evaluation or treatment within 24 hours by the Member’s PCP or PCP designee to prevent serious deterioration of the Member’s condition or health.
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Third Party Recovery. (TPR) means the recovery of payments on behalf of a Member by HHSC or the MCO from an individual or entity with the legal responsibility to pay for the Covered Services. Transfer means the movement of the Member from one (1) Acute Care Hospital or Long Term Care Hospital/facility and readmission to another Acute Care Hospital or Long Term Care Hospital/facility within 24 hours for continued treatment. Transition Phase includes all activities the MCO is required to perform between the Contract Effective Date and the Operational Start Date for an MCO Program and all or part of a Service Area. Turnover Phase includes all activities the MCO is required to perform in order to close out the Contract and/or transition Contract activities and operations to HHSC or a subsequent contractor. Turnover Plan means the written plan developed by MCO, approved by HHSC, to be employed during the Turnover Phase.
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Third Party Recovery means, with respect to an Environmental Remediation Cost, the actual amount recovered (or, if such amount has not yet been recovered, Tronox’s reasonable and good faith estimate of the amount that will be recovered) by any member of the Tronox Group (i) from any Potentially Responsible Parties (as such term is defined in regulations and judicial decisions construing and applying the Comprehensive Environmental Response, Compensation and Liability Act) or other parties who may be obligated for indemnity or contribution under other applicable law (in each case other than any member of the Parent Group), (ii) from any Governmental Authority, and (iii) under any applicable insurance policies maintained by any member of the Tronox Group or previously issued to such member’s predecessor in interest.
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Examples of Third Party Recovery in a sentence

  • After 120 days from the date of adjudication (on any claim, encounter, or other Medicaid related payment made by the MCO, wherein the claim, encounter, or payment is subject to Third Party Recovery), HHSC may attempt recovery, independent of any MCO action.

  • The file contains any Third Party Recovery (TPR) data that HHSC's claims administration agent has on file for individual Medicaid clients, organized by name and client number, and adding additional relevant information where available, such as the insured's name/contact information, type of coverage, the insurance carrier, and the effective dates.

  • After 120-days from the date of service on any claim, encounter, or other Medicaid related payment by the HMO subject to Third Party Recovery, HHSC may attempt recovery independent of any HMO action.

  • CHIP HMOs are authorized to engage in Third Party Recovery (TPR) actions for claims resulting from the care and/or treatment of CHIP Members.

  • CHIP Perinatal HMOs are authorized to engage in Third Party Recovery (TPR) actions for claims resulting from the care and/or treatment of CHIP Perinatal Program Members.

  • Note: Any time you learn the a/b or financially responsible spouse or parent created a trust or is the beneficiary of a trust, report it to DMA, Third Party Recovery Section.

  • After 120-days from the date of adjudication on any claim, encounter, or other Medicaid related payment by the HMO subject to Third Party Recovery, HHSC may attempt recovery independent of any HMO action.

  • However, this anti- assignment provision will not apply (1) to a Member’s assignment pursuant to Section X: Third Party Recovery Provision; or(2) to the extent required under Medicaid laws.

  • HMO must require all providers to comply with the provisions of 25 TAC Section 28, relating to Third Party Recovery in the Medicaid program.

  • COUNTY has contracted for Third Party Recovery Services (Recovery Services) for the 14 purpose of actively pursuing reimbursement of claims paid for MSN Enrollees later determined to be 15 eligible for Medi-Cal or third party, primary or other insurance.


More Definitions of Third Party Recovery

Third Party Recovery has the meaning specified in Section 9.9.
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Third Party Recovery means a payment made to a registered undertaking as a result of payments made by a third party for fees or charges arising from the provision of prescribed health services to an insured person other than payments made in respect of a contract of reinsurance.
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Third Party Recovery means a payment to a registered undertaking as a result of the acceptance by a third party of full or partial liability for fees or charges arising from the provision of prescribed health services to an insured person.
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Third Party Recovery means any recovery from any source of any amount paid with respect to a Covered Claim, including, without limitation, recovery pursuant to subrogation or reimbursement, recovery of any overpayment or impermissible payment to a health care provider, and recovery of any amount determined to have been paid as a result of fraud or abuse.
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Third Party Recovery. (TPR) means the recovery of payments on behalf of a Member by HHSC or the HMO from an individual or entity with the legal responsibility to pay for the Covered Services. TP 40 means Type Program 40, which is a Medicaid program eligibility type assigned to pregnant women under 185% of the federal poverty level (FPL).
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Third Party Recovery. (TPR) means the recovery of payments made on behalf of a Member by TDH or HMO from an individual or entity with the legal responsibility to pay for the services. TXMHMR means Texas Mental Health and Mental Retardation system which includes the state agency, TDMHMR, and the Local Mental Health and Mental Retardation Authorities. Unclean claim means a claim that does not contain accurate and complete data in all claim fields that are required by HMO and TDH and other HMO-published requirements for adjudication, such as medical records, as appropriate (see definition of Clean Claim).
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Related to Third Party Recovery

  • Net Recovery Any proceeds received by a Servicer on a delinquent or Charged Off Loan (including any Liquidation Proceeds received on a Charged Off Loan), net of any Servicing Fee, Ancillary Income and any other related expenses.

  • Third Party Originating Carrier means a Telecommunications Carrier that originates Transit Traffic that transits AT&T-TSP’s network and is delivered to CLEC.

  • Energy recovery means the use of combustible packaging waste as a means to generate energy through direct incineration with or without other waste but with recovery of the heat;

  • Cost recovery means collection, upon approval by the commission pursuant to its authority under section4909.15 of the Revised Code, of such documented EDU interconnection costs that are incurred at reasonable levels for prudent purposes and that are over and above the review processing fees set forth in rules 4901:1-22-06 to 4901:1-22-08 of the Administrative Code.

  • Postpartum recovery means (a) the entire period a woman or

  • Subsequent Recovery Any amount recovered by a Servicer or the Master Servicer with respect to a Liquidated Mortgage Loan with respect to which a Realized Loss was incurred after the liquidation or disposition of such Mortgage Loan.

  • Third Party Servicer means any servicer appointed from time to time by the Assuming Institution or any Affiliate of the Assuming Institution to service the Shared-Loss Loans on behalf of the Assuming Institution, the identity of which shall be given to the Receiver prior to or concurrent with the appointment thereof.

  • Special Servicer Servicing Personnel The divisions and individuals of the Special Servicer who are involved in the performance of the duties of the Special Servicer under this Agreement.

  • Non-Lead Special Servicer means the “special servicer” under any Non-Lead Securitization Servicing Agreement.

  • CMSA Special Servicer Loan File format substantially in the form of and containing the information called for therein for the Mortgage Loans, or such other form for the presentation of such information as may be approved from time to time by the CMSA for commercial mortgage securities transactions generally and, insofar as it requires the presentation of information in addition to that called for by the form of the "CMSA Special Servicer Loan File" available as of the Closing Date on the CMSA website, is reasonably acceptable to the Special Servicer.

  • Subsequent Recoveries As to any Distribution Date, with respect to a Liquidated Mortgage Loan that resulted in a Realized Loss in a prior calendar month, unexpected amounts received by the Master Servicer (net of any related expenses permitted to be reimbursed pursuant to Section 3.08) specifically related to such Liquidated Mortgage Loan.

  • Shared vehicle means a vehicle that is available for

  • Recovery has the meaning set forth in Section 6.4.

  • Net Recoveries means gross Recoveries during any Calendar Quarter minus Reimbursable Expenses during such Calendar Quarter.

  • Shared vehicle driver means an individual who has been authorized to drive the

  • Outside Special Servicer With respect to an Outside Serviced Mortgage Loan, the special servicer under the applicable Outside Servicing Agreement.

  • Insurance Proceeds With respect to each Mortgage Loan, proceeds of insurance policies insuring the Mortgage Loan or the related Mortgaged Property.

  • Non-Lead Securitization means any Securitization of a Note in a Securitization Trust other than the Lead Securitization.

  • Recoveries means, with respect to any Receivable that becomes a Liquidated Receivable, monies collected in respect thereof, from whatever source, during any Collection Period following the Collection Period in which such Receivable became a Liquidated Receivable, net of the sum of any amounts expended by the Servicer for the account of the Obligor and any amounts required by law to be remitted to the Obligor.

  • Master Servicer Servicing Personnel The divisions and individuals of the Master Servicer who are involved in the performance of the duties of the Master Servicer under this Agreement.

  • Certificate Insurance Policy The Financial Guaranty Insurance Policy No. CA01172A, and all endorsements thereto dated the Closing Date, issued by the Certificate Insurer for the benefit of the Class AF-3 Certificateholders.

  • Non-Lead Servicer means any Non-Lead Master Servicer or Non-Lead Special Servicer, as the context may require.

  • Non-Lead Securitization Servicing Agreement shall have the meaning assigned to such term in Section 2(b).

  • Lead Securitization PSA means the Note A-1 PSA.

  • Lead Securitization Servicing Agreement means (i) the pooling and servicing agreement or other comparable agreement related to the Lead Securitization, and (ii) on and after the date on which the Mortgage Loan is no longer subject to the provisions of the Lead Securitization Servicing Agreement, the “Lead Securitization Servicing Agreement” shall be determined in accordance with the second paragraph of Section 2(a).

  • CREFC® Special Servicer Loan File The data file in the “CREFC® Special Servicer Loan File” format substantially in the form of and containing the information called for therein for the Mortgage Loans, or such other form for the presentation of such information as may be approved from time to time by the CREFC® for commercial mortgage securities transactions generally.