Financial Incentives. XXXXX shall not provide PROVIDER with any financial incentive to withhold Covered Services, which are Medically Appropriate. Further, the Parties hereto agree to comply with and to be bound by, to the same extent as if the sections were restated in their entirety herein, the provisions of 42 CFR §417.479 and 42 CFR §434.70, as amended by the final rule effective January 1, 1997, and as promulgated by the CMS (formerly the Health Care Financing Administration, DHHS). In part, these sections govern physician incentive plans operated by federally qualified health maintenance organizations and competitive medical plans contracting with the Medicare program, and certain health maintenance organizations and health insuring organizations contracting with the Medicaid program. As applicable and pursuant to 42 CFR §417.479 and 42 CFR §434.70, no specific payment will be made directly or indirectly, under Plans hereunder to a physician or physician group, as an inducement to reduce or limit medically necessary services furnished to a Member.
Financial Incentives. Medical Management decision making is based only on Medical Necessity criteria, a member’s benefit plan, individual needs and circumstances, and the local delivery system. We do not reward or compensate Physicians, Providers, or other individuals for issuing denials of coverage. No financial incentives are given to staff to encourage decisions that result in underutilization. FRAUD OR MISREPRESENTATION Fraudulent statements and/or intentional misrepresentation on application forms, claims, Identification Cards or other identification to obtain services or a higher level of benefits are prohibited. This includes, but is not limited to, the fabrication and/or alteration of a claim, Identification Card or other identification. Misrepresentation involving all media (paper or electronic) may invalidate any payment or claims for services and be grounds for rescinding coverage. This includes fraudulent acts to obtain medical services and/or Prescription Drugs. Unauthorized use of your Identification Card, by you or an unauthorized person, or if you fraudulently use the Identification Card of another covered person, including but not limited to the use of card before coverage is in effect or after coverage has ended. Under these circumstances, the person who receives the services provided by misuse of the Identification Card will be responsible for payment of those services. Fraudulent misuse could also result in termination of the coverage. MEDICAL XXXX REVIEW (MBR) AND CLAIM AUDIT PROVISION All health care providers must submit Clean Claims. Alliant reserves the right to request and review medical records in order to allow for the determination of benefits according to the Contract. In accordance with Alliant’s policies and procedures, no benefits will be payable by Alliant if the health care provider does not submit a Clean Claim, obtain required Prior Authorization approvals, and submit upon request complete/legible itemization and complete/legible medical records. At Alliant’s discretion, all claims are subject to audit by Alliant or by an independent xxxx review firm and/or claim auditor. Alliant’s medical xxxx audit may be performed with or without records, and the review is not subject to waiver by any third-party agreement including, but not limited to, any Provider Network Agreement(s), unless specifically prohibited, or other re-pricing arrangements, or the guidelines of any health care provider (e.g., physician, hospital or other facility). Alliant wil...
Financial Incentives. The Parties acknowledge and agree that nothing in this Agreement shall be construed to create any financial incentive for Provider or a Contracted Provider to withhold Covered Services.
Financial Incentives. Nothing in this Agreement shall, or shall be construed to, create any financial incentive for Provider to withhold Medically Necessary services.
Financial Incentives. Utilization Management decision making is based only on the appropriateness of care and services, and the existence of coverage at the time the care was rendered. Alliant does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM staff or agents do not encourage decisions that result in underutilization.
Financial Incentives. All tenants will be required to either purchase a VTA Eco Pass for bus and light rail for each full-time employee, or purchase a monthly pass (or equivalent) at a cost of up to $65 per month for each employee who commutes via public transportation on a substantially full-time basis. The tenant may elect to offer both incentives.
Financial Incentives. Financial incentives have been shown to be strong motivators for use of public transit for many commuters. Undercurrent federal law, it is relatively easy for employers to subsidize the use of public transit for their employee's travel to work, and these subsidies are exempt from federal income taxes if the monthly subsidy does not exceed $65. It is much more difficult to subsidize the use of carpools, bicycles, and other commute alternatives without incurring federal income tax liabilities. To take maximum advantage of the tax-exempt, transit subsidies now available, all tenants will be required to either:
Financial Incentives. All homes must meet ENERGY STAR requirements to be eligible for the ENERGY STAR rebate, or meet a HERS Index score of 56 or lower. After that prerequisite is met, participating builders are eligible for a performance incentive based on the fuel that Consumers Energy provides the home. Up-to-date rebate incentive structure is available on XxxxxxxxxXxxxxxXxxxxXxxx.xxx HERS Rating Company Commitments HERS Rating companies who work within the Program are required to abide by the following commitments. Failure to meet these commitments will result in the suspension or termination of the HERS Rater Trade Ally Participation Agreement by ICF.
Financial Incentives. Medical Management decision making is based only on Medical Necessity criteria, a Member’s benefit plan, individual needs and circumstances, and the local delivery system. We do not reward or compensate Physicians, Providers, or other individuals for issuing denials of coverage. No financial incentives are given to staff to encourage decisions that result in underutilization. FRAUD OR MISREPRESENTATION Fraudulent statements and/or intentional misrepresentation on application forms, claims, Identification Cards or other identification to obtain services or a higher level of benefits are prohibited. This includes, but is not limited to, the fabrication and/or alteration of a claim, Identification Card or other identification. Misrepresentation involving all media (paper or electronic) may invalidate any payment or claims for services and be grounds for rescinding coverage. This includes fraudulent acts to obtain medical services and/or Prescription Drugs. Unauthorized use of Your Identification Card, by You or an unauthorized person, or if You fraudulently use the Identification Card of another covered person, including but not limited to the use of card before coverage is in effect or after coverage has ended. Under these circumstances, the person who receives the services provided by misuse of the Identification Card will be responsible for payment of those services. Fraudulent misuse could also result in termination of the coverage.
Financial Incentives. (a) The Project will provide a financial subsidy to the Project Beneficiary through a partial reimbursement of the cost of acquiring the new chiller equivalent up to fifteen percent (15%) of the ex-works price of the new chiller or fifteen percent (15%) of the Normative Cost, whichever is lower. The remaining costs to be incurred up to chiller commissioning shall be borne by the Project Beneficiary.
