Payment Recoveries. The Company shall take appropriate steps as it would for its own business under similar circumstances to collect Claim Payment Recoveries. The Company shall not be required to initiate court proceedings to recover a Claim Payment Recovery but is expressly authorized to take all actions to pursue recovery, including retaining counsel, settling and compromising claims, and delegating recovery to a third-party vendor to assist it in its collection efforts. For any Claim Payment Recoveries initially identified by the Company, the Company first attempts to pursue recovery itself. If the Company is unable to recover Claim Payment Recoveries, it may retain a third-party vendor(s) to assist with the recovery. In such instances, the amount to be credited as the returned claim money will be net of any fees charged by such vendor or counsel. The Company’s decision to retain a third party vendor(s) to assist with recovery may be based upon the amount of the Claim Payment Recoveries or other factors as determined by the Company. The Company currently retains third-party vendors to assist with recovery for Claim Payment Recoveries that are in excess of specified minimum amounts. That threshold may change from time to time, at the Company’s sole discretion. For further information on the Company’s current practices, please contact your Company account representative.
Payment Recoveries. The Company shall take appropriate steps as it would for its own business under similar circumstances to collect Claim Payment Recoveries. Company shall also take appropriate steps as it would for its own business under similar circumstances to collect pay for performance payments payable to Client or pay for performance overpayments (collectively “Pay for Performance Recoveries”). The Company shall not be required to initiate court proceedings to recover a Pay for Performance Recovery or a Claim Payment Recovery, but is expressly authorized to take all actions to pursue recovery including retaining counsel, settling and compromising claims, and delegating recovery to a third party vendor to assist it in its collection efforts. For any Pay for Performance Recoveries or Claim Payment Recoveries initially identified by the Company, the Company first attempts to pursue recovery itself. If the Company is unable to recover Pay for Performance Recoveries or Claim Payment Recoveries, it may retain a third party vendor(s) to assist with the recovery. In such instances, the amount of money returned to the Plan will be net of any fees charged by such vendor or counsel. The Company’s decision to retain a third party vendor(s) to assist with recovery may be based upon the amount of the Pay for Performance Recoveries or the Claim Payment Recoveries or other factors as determined by Company. The Company currently retains third party vendors to assist with recovery for Pay for Performance Recoveries and Claim Payment Recoveries that are in excess of specified minimum amounts. That threshold may change from time to time, at the Company’s sole discretion. For further information on the Company's current practices, please contact your Company account representative. For any Pay for Performance Recoveries or Claim Payment Recovery amounts that are first identified by a vendor, regardless of the cause, including but not limited to Payments made without regard to other coverage of the Member, if the Company uses the services of a vendor to collect the Pay for Performance Recoveries or Claim Payment Recovery, the Client agrees to reimburse the Company up to 35.4% of the returned Pay for Performance Recoveries or Claim Payment Recovery for collection costs.
Payment Recoveries i. Post-payment recoveries are categorized by (a) health-related insurance resources and (b) other resources. Health-related insurance resources are ERISA health benefit plans, Blue Cross/Blue Shield subscriber contracts, Medicare, private health insurance, workers compensation, and health insurance contracts.
