Eligibility Verification for Fully Dual Eligible Members Sample Clauses

Eligibility Verification for Fully Dual Eligible Members. If Contractor is affiliated with or contracted with a Medicare Advantage plan for Fully Dual Eligibles for Medicare and Medicaid, Contractor shall verify current Member eligibility using the AVR system or the MMIS Web Portal.
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Eligibility Verification for Fully Dual Eligible Members a. If Contractor is Affiliated with or contracted with a Medicare Advantage plan for FBDEs for Medicare and Medicaid, Contractor shall use 834 Electronic Data Interchange transaction set and 270/271 Health Care Eligibility Benefit Inquiry and Response transaction sets, and share Member information in the EDI 834 Benefit Enrollment and Maintenance files with its Affiliated MA or DSN Plans (or both of them as applicable) .
Sample 1

Related to Eligibility Verification for Fully Dual Eligible Members

  • Employee Eligibility Verification The Contractor warrants that it fully complies with all Federal and State statutes and regulations regarding the employment of aliens and others and that all its employees performing work under this Contract meet the citizenship or alien status requirement set forth in Federal statutes and regulations. The Contractor shall obtain, from all employees performing work hereunder, all verification and other documentation of employment eligibility status required by Federal or State statutes and regulations including, but not limited to, the Immigration Reform and Control Act of 1986, 8 U.S.C. §1324 et seq., as they currently exist and as they may be hereafter amended. The Contractor shall retain all such documentation for all covered employees for the period prescribed by the law. The Contractor shall indemnify, defend with counsel approved in writing by County, and hold harmless, the County, its agents, officers, and employees from employer sanctions and any other liability which may be assessed against the Contractor or the County or both in connection with any alleged violation of any Federal or State statutes or regulations pertaining to the eligibility for employment of any persons performing work under this Contract.

  • Eligibility Verification (a) HHSC will verify Medicaid eligibility for Dual Eligible Members by the fifth business day of the month following the receipt of the MA Dual SNP’s monthly enrollment file, in accordance with Section 3.02(b).

  • Employment Eligibility Verification As required by IC § 22-5-1.7, the Contractor swears or affirms under the penalties of perjury that the Contractor does not knowingly employ an unauthorized alien. The Contractor further agrees that:

  • Service Eligibility A bonus authorized by subsection (a) may be paid to a person or offi- cer only if the person or officer agrees under subsection (d)—

  • Full Employer Contribution - Basic Eligibility Employees covered by this Agreement who are scheduled to work at least seventy-five (75) percent of the time are eligible for the full Employer Contribution. This means:

  • Client Eligibility Client eligibility and service referral are the responsibility of DDA under chapter 388- 823 WAC (Eligibility) and chapter 388-825 WAC (Service Rules). Only persons referred by DDA shall be eligible for direct Client services under this Program Agreement. It is DDA’s responsibility to determine and authorize the appropriate direct service(s) type. Direct Client services provided without authorization are not reimbursable under this Program Agreement.

  • Program Eligibility 1. All officers, regardless of assignment, will be eligible for the vehicle program subject to the limitations set forth below.

  • Spousal Eligibility a. For employees hired on or after August 1, 2003: If the spouse of an employee is covered by any PEBTF health care plan, and he/she is eligible for coverage under another employer’s plan(s), the spouse shall be required to enroll in each such plan, which shall be the spouse’s primary coverage, as a condition of the spouse’s eligibility for coverage by the PEBTF plan(s), without regard to whether the spouse’s plan requires cost sharing or to whether the spouse’s employer offers an incentive to the spouse not to enroll.

  • Student Eligibility A. The Texas Success Initiative (TSI) requires mandatory assessment for all students to determine college readiness in reading, writing and math. The xxxx authorizes the Texas Higher Education Coordinating Board to prescribe assessment instruments with a statewide passing standard. The initiative allows an institution to determine when a student is ready to perform college‐level coursework. High School students who seek to register in a dual credit course, which will grant college credit must prove “college readiness” by achieving a college level score as outlined in Appendix A.

  • Member Eligibility Verify Member eligibility contemporaneous with the rendering of services. BCBS will provide systems and/or methods for verification of eligibility and benefit coverage for Members. This is furnished as a service and not as a guarantee of payment;

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