Common use of Balance Billing Clause in Contracts

Balance Billing. In accordance with 42 CFR § 447.15, Provider shall accept United’s payment as payment in full except for any applicable cost-sharing requirements under the State Contract, and shall not bill or balance bill Covered Persons for Covered Services provided during the Covered Person’s enrollment period. The collection or receipt of any money, gift, donation or other consideration from or on behalf of a Covered Person for any Covered Service provided is expressly prohibited. Provider agrees to hold Covered Persons harmless for charges for any Medicaid covered service. This includes those circumstances where the Provider fails to obtain necessary referrals, service authorization, or fails to perform other required administrative functions. Should an audit by United or an authorized State or federal official result in disallowance of amounts previously paid to Provider, Provider will reimburse United upon demand. Provider shall not bill Covered Persons in these instances. Provider agrees not to bill Covered Person for Medically Necessary services covered under the State Contract and provided during the Covered Person’s period of enrollment with United. This provision shall continue to be in effect even if United becomes insolvent. i) Debts of United in the event of United’s insolvency. ii) Payment for services provided by United if United has not received payment from the Department for the services or if Provider, under contract or other arrangement with United, fails to receive payment from the Department or United. iii) Payments to Provider that are in excess of the amount that normally would be paid by the Covered Person if the service had been received directly from United. This provision shall survive any termination of the Agreement, including breach of the Agreement due to insolvency.