Medicaid Payments Sample Clauses

Medicaid Payments. MDCH will provide the Prepaid Inpatient Health Plan (PIHP) two managed care payments each month for the Medicaid covered specialty services.
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Medicaid Payments. MDHHS will provide the PIHP eight managed care payments each month for the Medicaid covered specialty services under the listed Benefit Plan (BP). When applicable, additional payments may be scheduled (e.g. retro-rate implementation and up to 6 months retro eligibility). HIPAA compliant 834 and 820 transactions will provide eligibility and remittance information. • Base Rates for Benefit Plan (BHMA, BHMA-MHP, BHMA-HMP, BHMA-HMP-MHP, HSW- MC, SED-MC, CWP-MC) • Recovery of payments previously made for beneficiaries prior to MDHHS notification of death • Recovery of payments previously made for beneficiaries, who upon retrospective review, did not meet all the Benefit Plan enrollment requirements • Modifications to any of the Benefit Plan’s rate development factors • For HSW enrollees of a PIHP that includes the county of financial responsibility (COFR), referred to as the “responsible PIHP”, but whose county of residence is in another PIHP, referred to as the “residential PIHP”, the HSW capitation payment will be paid to the COFR within the “responsible PIHP” based on the multiplicative factor for the “residential PIHP”. The PIHP must be able to receive and transmit HIPAA compliant files, such as: • 834 – Enrollment/Eligibility • 820 – Payment / Remittance Advice • 837 – Encounter
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Medicaid Payments. For Medicaid Products, in the event the State Department of Health fails to provide or delays payment to Plan for the provision of Covered Services to Medicaid Members, Plan will suspend payment to Provider until such time as Plan receives payment from the Department. Plan will compensate Provider in a timely manner once payment is received from the Department. To the extent that the Department reduces any payments provided to Plan under the Medicaid program in any manner, Plan also will make corresponding reductions to any payments to Provider.
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Related to Medicaid Payments

  • Overtime Payments (1) Subject to the provisions of this subclause, all work performed outside of the Ordinary Hours and time worked to accrue an RDO on any day, Monday to Friday, inclusive, shall be paid for at the rate of time and one half for the first two hours and double time thereafter.

  • Billings and Payments Billings and payments shall be sent to the addresses set out in Appendix F.

  • ALLOWABLE COSTS AND PAYMENTS A. The method of payment for this contract will be based on actual cost plus a fixed fee. COUNTY will reimburse CONSULTANT for actual costs (including labor costs, employee benefits, travel, equipment rental costs, overhead and other direct costs) incurred by CONSULTANT in performance of the work. CONSULTANT will not be reimbursed for actual costs that exceed the estimated wage rates, employee benefits, travel, equipment rental, overhead, and other estimated costs set forth in the approved CONSULTANT’S COST PROPOSAL as referenced and defined in Exhibit “C”, unless additional reimbursement is provided for by contract amendment. In no event, will CONSULTANT be reimbursed for overhead costs at a rate that exceeds COUNTY’s approved overhead rate set forth in the COST PROPOSAL. In the event, that COUNTY determines that a change to the work from that specified in the COST PROPOSAL and AGREEMENT is required, the AGREEMENT time or actual costs reimbursable by COUNTY shall be adjusted by written agreement or task order to accommodate the changed work. The maximum total cost as specified in Paragraph “H” shall not be exceeded, unless authorized by written agreement.

  • Volunteer Payments You must not, except at your own cost, voluntarily make any payments, assume any obligations, or incur any other expenses except first aid to others at the time of bodily injury.

  • CORRUPT GIFTS AND PAYMENTS OF COMMISSION 31.1 The Contractor shall not do (and warrants that in entering the Contract it has not done) any of the following:

  • Copayments Effective January 1, 2019, the State Dental Plan will cover allowable charges for the following services subject to the copayments and coverage limits stated. Higher out-of-pocket costs apply to services obtained from dental care providers not in the State Dental Plan network. Services provided through the State Dental Plan are subject to the State Dental Plan's managed care procedures and principles, including standards of dental necessity and appropriate practice. The plan shall cover general cleaning two (2) times per plan year and special cleanings (root or deep cleaning) as prescribed by the dentist. Service In-Network Out-of-Network Diagnostic/Preventive 100% 50% after deductible Fillings 80% after deductible 50% after deductible Endodontics 80% after deductible 50% after deductible Periodontics 80% after deductible 50% after deductible Oral Surgery 80% after deductible 50% after deductible Crowns 80% after deductible 50% after deductible Implants 80% after deductible 50% after deductible Prosthetics 80% after deductible 50% after deductible Prosthetic Repairs 80% after deductible 50% after deductible Orthodontics* 80% after deductible 50% after deductible

  • Criminal Penalties Any individual director, officer, or employee of the contractor or of its subcontractors and suppliers who are indemnified under the provisions of this clause are subject to criminal penalties, pursuant to section 223(c) of the Act, for knowing and willful violation of the Atomic Energy Act of 1954, as amended, and applicable DOE nuclear safety-related rules, regulations or orders which violation results in, or, if undetected, would have resulted in a nuclear incident.

  • Coverage F – Medical Payments To Others We will pay the necessary medical expenses that are incurred or medically ascertained within three years from the date of an accident causing "bodily injury". Medical expenses means reasonable charges for medical, surgical, x-ray, dental, ambulance, hospital, professional nursing, prosthetic devices and funeral services. This coverage does not apply to you or regular residents of your household except "residence employees". As to others, this coverage applies only:

  • Xxxx Payments You may authorize new payment instructions or edit previously authorized payment instructions for xxxx payments that are either periodic and nonrecurring (e.g., payments on merchant charge accounts that vary in amount) or automatic and recurring (e.g., fixed mortgage payments). When you transmit a xxxx payment instruction to us, you authorize us to transfer funds to make the xxxx payment transaction from the account you designate. We will process xxxx payment transfer requests only to such payees as you authorize and for whom the Credit Union has the proper vendor code number. The Credit Union will not process any xxxx payment transfer if the required transaction information is incomplete. If there are insufficient funds in your account to make the xxxx payment request, we may either refuse to make the payment or make the payment and transfer funds from any overdraft protection account you have established. The Credit Union reserves the right to refuse to process payment instructions that reasonably appear to the Credit Union to be fraudulent or erroneous. The Credit Union will withdraw the designated funds from your account by 9:00am on the date of the scheduled payment if scheduled on a business day. If scheduled on a non-business day, the Credit Union will withdraw the funds by 9:00am on the first business day after the scheduled date. It is your responsibility to schedule your xxxx payments in such a manner that your obligations will be paid on time. You should enter and transmit your xxxx payment instructions at least 10 days before a xxxx is due. You are responsible for any late payments or finance charges that may be imposed as a result of your failure to transmit timely payment authorization. You may cancel or stop payment on periodic xxxx payments and automatic, recurring xxxx payment instructions under certain circumstances. If you discover an error in or want to change a payment instruction (e.g., payment date or payment amount) for a periodic or automatic payment you have already scheduled for transmission through online or mobile banking, you may electronically edit or cancel your payment through online or mobile banking. Your cancellation request must be entered and transmitted before the date you have scheduled for payment. If your request is not entered in time, you will be responsible for the payment. If you wish to place an oral stop payment on an automatic, recurring xxxx payment transaction, the Credit Union must receive your oral stop payment request at least three (3) business days before the next payment is scheduled to be made. You may call the Credit Union at the telephone number set forth in Section 4 (Member Liability) to request a stop payment. If you call, the Credit Union may require you to confirm your stop payment request in writing within 14 days after the call.

  • CONTRACTUAL PENALTIES 1. Should the Accommodated Person fail to pay the price for the accommodation in the agreed amount, by the due date and under the correct variable symbol, he/she is obliged to pay interest on late payments under Section 10(2) of Act No. 176/2004 Coll., on the Disposal of the Property of Public Institutions and the Amendment to Act No. 259/1993 of the National Council of the Slovak Republic, on the Slovak Forestry Chamber, as amended by Act No. 464/2002 Coll., as amended. In addition, he/she is obliged to pay a contractual penalty (even if the contractual obligations are breached not through a fault of the Accommodated Person, e.g., by error of the financial institution) in the amount of 0.3 % of the amount due for each day of delay. The agreement regarding the contractual penalty shall not affect the Landlord’s entitlement to demand compensation for damages. Both entitlements can be exercised by the Landlord concurrently. Both the contractual penalty and the interest on late payments are to be paid via a separate bank transfer to the Landlord’s account stated in Article I in the “Landlord” section hereof (separately from the price for the accommodation).

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