Common use of Coordination of Benefit Clause in Contracts

Coordination of Benefit. Notwithstanding any other provision of this Agreement, PPG agrees to conduct Coordination of Benefits in accordance with the policies and procedures established by FHFS or a Payor for the applicable Benefit Program, PPG shall not xxxx Member for any portion of Covered Services not paid by the primary carrier when FHFS or a Payor is the secondary carrier, but shall instead seek compensation from FHFS or Payor for such service. When a Member has coverage which is primary through another carrier, then FHFS’ or a Payer’s compensation to PPG shall be limited to the difference between the amount paid by the primary carrier and the contract rates, including Copayments and cost shares.

Appears in 2 contracts

Samples: Provider Services Agreement (Prospect Medical Holdings Inc), Provider Services Agreement (Prospect Medical Holdings Inc)

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Coordination of Benefit. Notwithstanding any other provision of this Agreement, PPG agrees to conduct Coordination of Benefits in accordance with the policies and procedures established by FHFS or a Payor for the applicable Benefit Program, . PPG shall not xxxx bill Member for any portion of Covered Services not paid by the primary carrier earner when FHFS or a Payor is the secondary carrier, but shall instead seek compensation from FHFS or Payor for such service. When a Member has coverage which is primary through another carrier, then FHFS’ or a PayerPayor’s compensation to PPG shall be limited to the difference between the amount paid by the primary carrier and the contract rates, including Copayments and cost shares.

Appears in 1 contract

Samples: Dental Services (Prospect Medical Holdings Inc)

Coordination of Benefit. Notwithstanding any other provision of this Agreement, PPG agrees to conduct Coordination of Benefits in accordance with the policies and procedures established by FHFS or a Payor for the applicable Benefit Program, . PPG shall not xxxx Member for any portion of Covered Services not paid by the primary carrier when FHFS or a Payor is the secondary carrier, but shall instead seek compensation from FHFS or Payor for such service. When a Member has coverage which is primary through another carrier, then FHFS’ or a PayerPayor’s compensation to PPG shall be limited to the difference between the amount paid by the primary carrier and the contract rates, including Copayments and cost shares.

Appears in 1 contract

Samples: Group Provider Services Agreement (Prospect Medical Holdings Inc)

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Coordination of Benefit. Notwithstanding any other provision of this Agreement, PPG agrees to conduct Coordination of Benefits in accordance with the policies and procedures established by FHFS or a Payor for the applicable Benefit Program, . PPG shall not xxxx bill Member for any portion of Covered Services not paid by the primary carrier when FHFS or a Payor is the secondary carrier, but shall instead seek compensation from FHFS or Payor for such service. When a Member has coverage which is primary through another carrier, then FHFS, or a PayerPayor’s compensation to PPG shall be limited to the difference between the amount paid by the primary carrier and the contract rates, including Copayments and cost shares.

Appears in 1 contract

Samples: Group Provider Services Agreement (Prospect Medical Holdings Inc)

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