Payers Sample Clauses

Payers. 2.1 You agree and understand that you must provide clear and written instructions to your Payers to use their own bank or similar financial institution to send funds to us. You must provide Payers with enough information to understand that their payments are being processed by us on your behalf, and you will provide Payers with a confirmation receipt of payment when we receive this.
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Payers. From December 31, 2017 to the date of this Agreement, none of the ten (10) largest payers of Parent and its Subsidiaries (determined on the basis of aggregate revenues recognized by Parent and its Subsidiaries over the fiscal year ended December 31, 2018) have (a) canceled or otherwise terminated, or to the Knowledge of Parent, threatened to cancel or otherwise terminate, or not renew, its relationship with Parent or any of its Subsidiaries or (b) demanded, requested or received from Parent or any of its Subsidiaries any material concessions with respect to any existing or proposed Contracts or programs, or (c) been engaged in a material dispute with Parent or any of its Subsidiaries, in the case of each of clauses (a) (with respect to threatened matters), (b) and (c), other than to the extent in the ordinary course of business.
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Payers. Schedule 4.27 contains a list of the fifteen (15) largest payers of the Company for the twelve (12) month period immediately preceding the Closing Date (determined on the basis of the total dollar amount of gross sales) showing the total dollar amount of gross sales from each such payer during such twelve (12) month period. To the Knowledge of the Company, there are no facts indicating that any of the payers of the Company will not continue to be payers of the business of the Company after the Closing at substantially the same level of purchases as heretofore.
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Payers. Verbal agreement with Medicaid, Medicare, Commercial, and one self- insured plan. The ACO and plans are seeking to maximize alignment between Medicare, Medicaid, and commercial payers in: ❑ Total cost of care ❑ Attribution and payment mechanisms ❑ Patient protections ❑ Provider reimbursement strategies Additional Information Requested • Information on truncation of high-cost outlier individuals for Medicaid and Commercial • History of shared savings program performance • Clarification on reinsurance/risk mitigation (see Part 2) • Finalized payer contracts Part 4: Budget and Risk Observations • $18.5 million deductions from hospital fixed payments will be used to fund population health management programs and operations • $7.1 million will fund the Complex Care Coordination Program, a 629% increase from 2017 • $1.6 million is included for Community Program Investments • No capital costs were reported Additional Information Requested • Days cash on hand increased significantly from 2016 to 2017 • ‘Due to Other’ liability account on the balance sheet needs further explanation • Hospitals will confirm risk amounts and projected fixed payments Observations
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Payers. Practice shall have the sole and exclusive right and authority to enter into contractual relationships with patients, HMOs, IPAs, PPOs, ACOs, integrated delivery networks, employers, employer groups, governmental entities (including Federal Health Care Programs), public or private healthcare exchanges, or other managed care or reimbursement arrangements (collectively, “Payers”) on Physician’s behalf. Physician shall at all times remain credentialed as a participating provider by the Payers designated by Practice. Physician shall not contract with any Payers without Practice’s prior written consent. Physician agrees to solely accept the compensation paid to her by Practice for the Services under this Agreement and shall not seek or accept compensation from any Payer or any other person or entity for the Services. Upon request from Practice, Physician shall promptly provide any information and execute any relevant documents required by a Payer for credentialing or any other purpose.
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Payers. (Medicare, Medicaid, BCBSVT, etc.) Providers (Hospitals, Primary Care, Designated Agencies, etc.) Green Mountain Care Board Has regulatory oversight over OneCare Department of Vermont Health Access Oversees the Medicaid contract with OneCare 32 Vermont’s All-Payer Accountable Care Organization (ACO) Model - An Overview of the All-Payer ACO Model and the State’s Oversight of Vermont’s Only ACO, OneCare Vermont, LLC., Rpt No. 20-02, dated June 26, 2020. Table 7 shows the what GMCB reported that they billed regulated entities for fiscal year 2020 in order of highest to lowest. OneCare was the third highest entity billed. Table 7: Amount and Percent of Total Amount GMCB Billed to Regulated Entities in Fiscal Year 2020 Entity Type of Entity Amount Billed Percent of Total Amount Billed Blue Cross and Blue Shield of Vermont Insurance Company $1,249,916 31.2% University of Vermont Medical Center Hospital $966,372 24.1% OneCare ACO $366,111 9.1% MVP Health Plan Inc Insurance Company $205,807 5.1% Rutland Regional Medical Center Hospital $191,957 4.8% Central Vermont Medical Center Hospital $156,299 3.9% Southwestern Vermont Medical Center Hospital $123,498 3.1% Northwestern Medical Center Hospital $83,816 2.1% MVP Health Insurance Company Insurance Company $82,595 2.1% Cigna Health and Life Insurance Company/Connecticut General Life Ins Insurance Company $77,564 1.9% Brattleboro Memorial Hospital Hospital $63,185 1.6% Xxxxxx Medical Center Hospital $62,713 1.6% Northeastern Vermont Regional Hospital Hospital $62,546 1.6% North Country Hospital Hospital $59,943 1.5% Xxxxxx Hospital Hospital $52,083 1.3% Mt Ascutney Hospital Hospital $38,533 > 1% Xxxxxxx Medical Center Hospital $37,550 > 1% Springfield Hospital Hospital $35,045 > 1% Aetna Life Insurance Company Insurance Company $29,851 > 1% The Vermont Health Plan, LLC Insurance Company $28,792 > 1% UnitedHealthcare Insurance Company Insurance Company $15,005 > 1% Grace Cottage Hospital (Xxxxxx Xxxx) Hospital $14,313 > 1% Atlanta International Insurance Company Insurance Company $2,151 > 1% QCC Insurance Company Insurance Company $1,753 > 1% State Farm Mutual Automobile Insurance Company Insurance Company $1,339 > 1% AXA Equitable Life Insurance Company Insurance Company $184 > 1% United States Life Insurance Company in the City of New York Insurance Company $163 > 1% Entity Type of Entity Amount Billed Percent of Total Amount Billed Sierra Health and Life Insurance Company, Inc. Insurance Company $156 > 1% Trustmar...
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Related to Payers

  • Payer If the Liquidation Amount determined pursuant to this clause is a positive amount, you shall pay it to us and if it is a negative amount, we shall pay it to you. We shall notify you of the Liquidation Amount, and by whom it is payable, immediately after the calculation of such amount.

  • Pharmacy Pharmacy hereby represents that neither Pharmacy, nor, to the best of Pharmacy’s knowledge, Pharmacist, Pharmacy’s employees, agents or independent contractors involved in the provision of services have been excluded from participation in any Federally-funded health care programs, including, but not limited to, Medicare and Medicaid.

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S RESOURCES. Services reimbursed under Medicaid are outlined in Attachment “A” to this Agreement. Once a Medicaid application has been submitted on the Resident’s behalf, the Resident, Sponsor, and Resident Representative agree to pay, to the extent they have access to the Resident’s funds, to the Facility the Resident’s monthly income, which will be owed to the Facility under the Resident’s Medicaid budget. Medicaid recipients are required to pay their Net Available Monthly Income (“NAMI”) to the Facility on a monthly basis as a co-payment obligation as part of the Medicaid rate. A Resident’s NAMI equals his or her income (e.g., Social Security, pension, etc.), less allowed deductions. The Facility has no control over the determination of NAMI amounts, and it is the obligation of the Resident, Resident Representative and/or Sponsor to appeal any disputed NAMI calculation with the appropriate government agency. Once Medicaid eligibility is established, the Resident, Resident Representative and/or Sponsor agree to pay NAMI to the Facility or to arrange to have the income redirected by direct deposit to the Facility and to ensure timely Medicaid recertification. The Resident, Sponsor and Resident Representative agree to provide to the Facility copies of any notices (such as requests for information, budget letters, recertification, denials, etc.) they receive from the Department of Social Services related to the Resident’s Medicaid coverage. Until Medicaid is approved, the Facility may bill the Resident’s account as private pay and the Resident will be responsible for the Facility’s private pay rate. If Medicaid denies coverage, the Resident or the Resident’s authorized representative can appeal such denial; however, payment for any uncovered services will be owed to the Facility at the private pay rate pending the appeal determination. If Medicaid eligibility is established and retroactively covers any period for which private payment has been made, the Facility agrees to refund or credit any amount in excess of the NAMI owed during the covered period.

  • Patients The Dentist shall accept Covered Persons as patients as reasonably permitted by the Dentist's patient load and appointment calendar. The Dentist will provide Covered Dental Services to Covered Persons on the same basis as to the Dentist's other patients (for example: scheduling, quality of service, and fee charges). The Dentist will be solely responsible to Covered Persons for dental advice and treatment; SDC will have no control over Dentist's practice or the dentist-patient relationship.

  • Medi Cal PII is information directly obtained in the course of performing an administrative function on behalf of Medi-Cal, such as determining Medi-Cal eligibility or conducting IHSS operations, that can be used alone, or in conjunction with any other information, to identify a specific individual. PII includes any information that can be used to search for or identify individuals, or can be used to access their files, such as name, social security number, date of birth, driver’s license number or identification number. PII may be electronic or paper. AGREEMENTS

  • REGULATORY ADMINISTRATION SERVICES BNY Mellon shall provide the following regulatory administration services for each Fund and Series:  Assist the Fund in responding to SEC examination requests by providing requested documents in the possession of BNY Mellon that are on the SEC examination request list and by making employees responsible for providing services available to regulatory authorities having jurisdiction over the performance of such services as may be required or reasonably requested by such regulatory authorities;  Assist with and/or coordinate such other filings, notices and regulatory matters and other due diligence requests or requests for proposal on such terms and conditions as BNY Mellon and the applicable Fund on behalf of itself and its Series may mutually agree upon in writing from time to time; and

  • Subcontracting for Medicaid Services Notwithstanding any permitted subcontracting of services to be performed under this Agreement, Party shall remain responsible for ensuring that this Agreement is fully performed according to its terms, that subcontractor remains in compliance with the terms hereof, and that subcontractor complies with all state and federal laws and regulations relating to the Medicaid program in Vermont. Subcontracts, and any service provider agreements entered into by Party in connection with the performance of this Agreement, must clearly specify in writing the responsibilities of the subcontractor or other service provider and Party must retain the authority to revoke its subcontract or service provider agreement or to impose other sanctions if the performance of the subcontractor or service provider is inadequate or if its performance deviates from any requirement of this Agreement. Party shall make available on request all contracts, subcontracts and service provider agreements between the Party, subcontractors and other service providers to the Agency of Human Services and any of its departments as well as to the Center for Medicare and Medicaid Services.

  • Referrals It is expected that through employee awareness and educational programs, employees will seek information and/or assistance on their own initiative. Such requests will be processed as voluntary and informal rather than formal referrals.

  • Rosters 8.1 As far as practically possible, the Employer will draw up a roster 1 week in advance. Changes to rosters may occur with 24 hours notice or, subject to the availability of the Employee, with less notice if by mutual consent.

  • Students Payments which a student or business apprentice who is or was immediately before visiting a Contracting State a resident of the other Contracting State and who is present in the first-mentioned State solely for the purpose of his education or training receives for the purpose of his maintenance, education or training shall not be taxed in that State, provided that such payments arise from sources outside that State.

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