Process for Pre-Authorization of MLTSS Sample Clauses

Process for Pre-Authorization of MLTSS. All Member’s determined to be eligible to receive MLTSS shall be assigned a HNJH Care Manager who will conduct a face to face assessment of the Member for the purpose of identifying Member’s strengths, needs and goals, and to develop a Plan of Care outlining all services, including MLTSS HCBS and Nursing Facility Services when appropriate, to be provided which capitalize on Member’s strengths to meet identified needs and achieve goals. Care Manager shall promptly issue an Authorization number to Provider prior to the commencement of services by Provider. The authorization shall cover all periods of time from the commencement of Member’s admission to the facility where such care has been deemed medically necessary. Provider agrees to provide only those services included in the Member’s Plan of Care and authorized by the Care Manager. If provider feels that a change in Member’s condition warrants a change in type, frequency, amount or duration of services, Provider shall alert Member’s assigned Care Manager to request a re-assessment to determine if Plan of Care should be amended. It is understood and agreed by Provider that issuance of an Authorization for benefits represents an acknowledgment by Horizon NJ Health that, based upon information provided, MLTSS are necessary and appropriate and is not an assurance or guarantee of payment of a claim, and is additionally dependent on eligibility, as verified by the Provider. If Horizon NJ Health has provided Authorization for MLTSS, Horizon NJ Health shall not deny payment of a claim on grounds that MLTSS are not necessary and Appropriate, except in cases where there was material misrepresentation or fraud. The MLTSS Authorization number assigned by HNJH Care Manager MUST accompany any billing information submitted by Provider to Horizon NJ Health. Only those MLTSS included in the Plan of Care for which Provider has received an authorization number shall be submitted for payment.
Sample 1
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Related to Process for Pre-Authorization of MLTSS

  • Authorization of Agreement, Etc The Borrower has the right and power, and has taken all necessary action to authorize it, to borrow and obtain other extensions of credit hereunder. The Borrower and each other Loan Party has the right and power, and has taken all necessary action to authorize it, to execute, deliver and perform each of the Loan Documents to which it is a party in accordance with their respective terms and to consummate the transactions contemplated hereby and thereby. The Loan Documents to which the Borrower or any other Loan Party is a party have been duly executed and delivered by the duly authorized officers of such Person and each is a legal, valid and binding obligation of such Person enforceable against such Person in accordance with its respective terms except as the same may be limited by bankruptcy, insolvency, and other similar laws affecting the rights of creditors generally and the availability of equitable remedies for the enforcement of certain obligations (other than the payment of principal) contained herein or therein may be limited by equitable principles generally.

  • Authorization of Agreement This Agreement has been duly authorized, executed and delivered by the Company.

  • Authorization of Agreements The execution and delivery of this Amendment and the performance of the Amended Agreement have been duly authorized by all necessary corporate action on the part of Borrower.

  • Authorization and Application of Overtime (a) An employee who is required to work overtime shall be entitled to overtime compensation when:

  • Authorization of Agreements, Etc (a) The execution and delivery by the Company of this Agreement, the performance by the Company of its obligations hereunder, the issuance, sale and delivery of the Convertible Notes and the issuance and delivery of the Conversion Shares have been duly authorized by all requisite corporate action and will not violate (i) any provision of any law, order of any court or other agency of government applicable to the Company, the Certificate of Incorporation of the Company (the "Charter"), or the By-Laws of the Company, as amended, or (ii) any provision of any indenture, agreement or other instrument to which the Company or any of its properties or assets is bound, or (iii) conflict with, result in a breach of or constitute (with due notice or lapse of time or both) a default under any such indenture, agreement or other instrument, or (iv) result in the creation or imposition of any lien, charge, restriction, claim or encumbrance of any nature whatsoever upon any of the properties or assets of the Company, which in the cases of clauses (ii), (iii) and (iv) would have a Material Adverse Effect.

  • Authorization of Overtime (a) Overtime work shall be assigned and authorized only by appointing authorities or their designated representatives either verbally or in writing.

  • Power; Due Authorization; Binding Agreement The Stockholder has all requisite legal capacity, power and authority to execute and deliver this Agreement, to perform his obligations under this Agreement, and to consummate the transactions contemplated by this Agreement. This Agreement has been duly and validly executed and delivered by the Stockholder and constitutes a valid and binding agreement of the Stockholder, enforceable against the Stockholder in accordance with its terms, except as such enforcement may be limited by applicable bankruptcy, insolvency, reorganization, moratorium or similar Laws relating to or affecting the enforcement of creditors rights generally and equitable principles of general applicability.

  • Overtime Authorization All overtime must be authorized by the City Manager or his or her designated representative in advance of being worked.

  • Authorization of Services a. The Contractor and its subcontractors shall have in place, and follow, written authorization policies and procedures.

  • Corporate Authorization The execution, delivery and performance by Buyer of this Agreement and the consummation by Buyer of the transactions contemplated hereby are within the corporate powers of Buyer and have been duly authorized by all necessary corporate action. This Agreement constitutes a valid and binding Agreement of Buyer.

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