Provider Exclusions Sample Clauses

Provider Exclusions. The Division will not reimburse the Contractor for services rendered by any provider that is excluded from participation by Medicare, Medicaid, including any other states’ Medicaid program, or SCHIP, including any other states’ or SCHIP program, except for emergency services.
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Provider Exclusions. The Division will not reimburse the Contractor for services rendered by any provider that is excluded from participation by Medicare, Medicaid, including any other states’ Medicaid program, or SCHIP, including any other states’ or SCHIP program, except for emergency services. The Contractor must ensure that all their providers and subcontractor entities screen their employees for excluded persons. The Contractor must communicate this obligation to all providers and subcontractors upon credentialing and re-credentaling and upon renewal of any subcontracts. The Division will require the Contractor to search the HHS-OIG website by names of any individual or entity for exclusions and require this to be done monthly to capture exclusions and reinstatements. In addition, the Contractor may search List of Excluded Individuals and Entities (LEIE), Medicare Exclusion Databank (MED), National Practitioner Data Bank (NPDB), Health Integrity and Protection Databank (HIPDB), General Services Administration (GSA) Excluded Parties List Service (EPLS); State Board of Examiners. The Contractor must search the exclusions database monthly. These searches must include any providers, entities and individuals with ownership or control interests in any entity. The Division may impose civil monetary penalties against the Contractor if they employ or enter into a contract with excluded individuals or entities to provide items or services to Medicaid beneficiaries.
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Provider Exclusions. As to Provider’s liability, the Provider Cap for direct damages liability and the Section 16.3 limitation on non-direct damages shall not apply to: (a) Losses arising under or relating to Provider’s failure to comply with Article 8; (b) Losses resulting from Provider’s failure to comply with any Force of Law Requirements; (c) Losses arising under or relating to the gross negligence, willful misconduct or fraud of Provider; (d) any introduction by Provider or Provider Personnel of Malicious Code in the Commission’s environment, network or systems, to the extent Losses caused by such introduction arise from acts, errors or omissions of Provider or Provider Personnel that constitute gross negligence or willful misconduct; (e) personal injury, including death, and damage to tangible personal or real property caused by the grossly negligent, willful or intentional acts of a Provider or Provider Personnel; (f) amounts owed by Provider due to a Net Income Shortfall under Section 5.3.4; or (g) Provider’s wrongful termination of this Agreement or repudiation or wrongful abandonment of all or any part of the Services.
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Related to Provider Exclusions

  • Service Exclusions The Contractor shall not be responsible for any repairs necessitated by abuse, neglect, vandalism, Acts of God, fire or water. These repairs shall be the subject of a separate purchase order and shall not be performed under this contract.

  • GENERAL EXCLUSIONS We do not insure for loss caused directly or indirectly by any of the following. Such loss is excluded regardless of any other cause or event contributing concurrently or in any sequence to the loss. These exclusions apply whether or not the loss event results in widespread damage or affects a substantial area.

  • for exclusions The amount you pay for covered healthcare services can differ based on the following: • the service was provided in an inpatient or outpatient setting, in a physician’s office, in your home, or from a pharmacy; • the healthcare provider is from a network provider or non-network provider; • a deductible, a copayment, or a benefit limit applies; • you reached your plan year maximum out-of-pocket expense; • there are exclusions from coverage that apply; or • our allowance for a covered healthcare service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider.

  • Additional Exclusions The Insurer shall not be liable for: (i) expenses for “clean-up” away from or beyond the “premises” resulting from any spill, discharge, emission, dispersal, seepage, leakage, migration, release or escape of “pollutants” even if the “pollutants” emanated from the “premises”; (ii) expenses for “clean-up” of any spill discharge, emission, dispersal, seepage, leakage, migration or escape of “pollutants” that began before the effective date of this Policy; (iii) fines, penalties, punitive or exemplary damages; (iv) expenses incurred for the “clean-up” of “pollutants” at or from any “premises”, site or location which is or was at any time used by or for any Insured or others for the handling, storage, disposal, processing or treatment of waste.

  • Specific Exclusions Apart from the exclusions common to all covers, the following are also excluded. We do not intervene for: EMERGENCY SUITCASE DOMESTIC HELP DELIVERY OF HOUSEHOLD SHOPPING PSYCHOLOGICAL SUPPORT UPON YOUR RETURN HOME To allow us to intervene under the best conditions, remember to prepare the following information that will be requested when you call: When you call initially, you will be given an assistance file number. State it systematically during any subsequent contacts with our Assistance Service. - the policy came with the purchase of goods or a service sold by a supplier; - you can show that you are already covered for one of the risks covered by this new policy; - the policy you wish to cancel has not been fully established; - you have not declared any loss covered by this policy. In this situation, you can exercise your right to cancel this policy by letter or in any lasting medium sent to the insurer of the new policy, together with documentary proof that you already have cover for one of the risks covered by this new policy. The insurer must reimburse you the premium paid within thirty days of your cancellation. If you wish to cancel your policy but do not meet all the above conditions, please check the cancellation procedure stipulated in your policy.