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.

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.

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.

Examples of Third Party Recovery in a sentence

• If the member has retained an attorney to represent himself or herself with respect to a third-party claim, then the attorney must sign the Third-Party Recovery Agreement, acknowledging the obligations described in that agreement.

• If the Covered Individual has retained an attorney to represent the Covered Individual with respect to a Third-Party Claim, then the attorney must sign the Third-Party Recovery Agreement, acknowledging the obligations described in that Agreement.

• Do States Vary on How the Third-Party Recovery Affects Future Workers’ Compensation Benefits?Yes.

• Notwithstanding any language or provision to the contrary here or elsewhere, out-of-pocket maximums and other Member payment limitations established by contract or otherwise do not restrict Plan's rights to recover the full amount of Plan Costs from a Third-Party Recovery.

• Plan may assign the right to recover Plan Costs from a Third-Party Recovery to Plan Providers and/or others.

• The Third-Party Recovery (TPR) Unit has the responsibility for determining if an individual has failed, without good cause, to cooperate with assignment of third-party rights.

• Cf. Karen Wildau, Evolving Law of Third-Party Claims Under Fidelity Bonds: When Is Third-Party Recovery Allowed?, 25 Tort & Ins.

• In anticipation of obtaining a recovery if a Participant fails to comply with the Plan’s Third-Party Recovery, Subrogation and Reimbursement provisions; or6.

• Motion Picture Industry Health Plan B Lenai Mull’s Injury and Third-Party Recovery Lenai suffered serious injuries in February 2010 after the driver of the vehicle in which she was a passenger lost control and drove the vehicle off a 20-foot embankment.

• If the provider has knowledge of the liable third-party at the time of filing the claim, a completed Third-Party Recovery Accident Information Report (DMA-2043) must be submitted with the claim to NC Medicaid’s TPL Section at the address shown on the form.

More Definitions of Third Party Recovery

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.

Third Party Recovery has the meaning specified in Section 9.10.

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.

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).

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).

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.