Reimbursement for Preauthorized Care; Payment of Claims: MC Sample Clauses

Reimbursement for Preauthorized Care; Payment of Claims: MC. Rx shall not deny reimbursement for a preauthorized or approved service unless (i) the information submitted to the Plan Sponsor regarding the Drug Product and/or Service is fraudulent or intentionally misrepresentative; (ii) critical information regarding the Drug Product or Service to be delivered to the Patient was omitted such that the Plan Sponsor’s determination would have been different had it known the critical information; (iii) the treatment plan that was approved for the Covered Person was not followed by the Pharmacy; or (iv) the Covered Person was not covered by the Plan Sponsor on the date the preauthorized Drug Product or Service was delivered and the Plan Sponsor maintained an automated eligibility verification system that was available to the Pharmacy by phone or internet and according to such verification system, Covered Person was not covered by Plan Sponsor. A Plan Sponsor may suspend review of a preauthorized claim if the Covered Person is in the second or third month of a grace period for Covered Persons who are receiving advance payments of a federal premium tax credit for a Federal Qualified Health Plan and the Plan Sponsor maintains an automated eligibility verification system that is available to the health care provider by telephone or via the internet at the time the health care service was provided and according to the verification system (i) the Covered Person is in the second or third moth of a grace period and review of a claim for review may be suspended and (ii) Plan Sponsor is not prohibited from denying a claim for reimbursement of a suspended claim and the Plan Sponsor complies with the Maryland’s payment of claims statutes as more particularly described in Section 6 above.
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Related to Reimbursement for Preauthorized Care; Payment of Claims: MC

  • Payment of Costs and Legal Fees and Reinstatement of Benefits In the event any dispute or controversy arising under or in connection with the Executive’s termination is resolved in favor of the Executive, whether by judgment, arbitration or settlement, the Executive shall be entitled to the payment of (a) all legal fees incurred by the Executive in resolving such dispute or controversy, and (b) any back-pay, including Base Salary, bonuses and any other cash compensation, fringe benefits and any compensation and benefits due to the Executive under this Agreement.

  • Educational Reimbursement SECTION 1. The purpose of this Article is to xxxxxx a learning environment and provide educational opportunities that are mutually beneficial to the employees and the County and will encourage eligible employees to participate in education programs which will further their skills and knowledge for use in their current position or for use in a possible future position of greater responsibility. The Educational Reimbursement Program shall be a plan as provided for in Section 127 of the Internal Revenue Code of 1986, as amended (the “Code”) and shall be construed consistently with the requirements of Section 127. Amounts paid for tuition reimbursement meeting the requirements of Section 127 of the IRS Tax Code are not included in an Employee’s income or subject to income tax withholding up to a maximum of $5,250 annually. If subsequent tax law changes fail to continue the tax-free treatment, or in any way modify its treatment, appropriate adjustments in tax withholding will be made from the effective date of the change. This Article does not apply to training seminars, conferences, workshops, etc.

  • Transportation Reimbursement Employees who, during the course of their normal duties, are required to actually transport clients/consumers/felons in their own personal vehicle on a regular basis, are eligible for reimbursement for the cost of an automobile rider to their existing insurance policy. To be eligible for the reimbursement, the employee must demonstrate the following:

  • Reimbursement Procedures An employee must keep a record of each trip made. Reimbursement shall be for the actual mileage driven in the performance of assigned duties as verified by the appropriate school district administrator and in accordance with School District Business Office policies and procedures.

  • Submitting False Claims; Monetary Penalties The AOC shall be entitled to remedy any false claims, as defined in California Government Code section 12650 et seq., made to the AOC by the Contractor or any Subcontractor under the standards set forth in Government Code section 12650 et seq. Any Contractor or Subcontractor who submits a false claim shall be liable to the AOC for three times the amount of damages that the AOC sustains because of the false claim. A Contractor or Subcontractor who submits a false claim shall also be liable to the AOC for (a) the costs, including attorney fees, of a civil action brought to recover any of those penalties or damages, and (b) a civil penalty of up to $10,000 for each false claim.

  • Reimbursement of Travel Expenses If the Servicer provides access to the Review Materials at one of its properties, the Issuer will reimburse the Asset Representations Reviewer for its reasonable travel expenses incurred in connection with the Review on receipt of a detailed invoice.

  • Extended Health Care Benefits 12.02(a) The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended. Eligible Expenses (Benefit year January 1 – December 31)

  • Treatment of Unallowable Costs Previously Submitted for Payment The Debtors further agree that within 90 days of the Effective Date of this Agreement they shall identify to applicable Medicare and TRICARE fiscal intermediaries, carriers, and/or contractors, and Medicaid and FEHBP fiscal agents, any Unallowable Costs (as defined in this Paragraph) included in payments previously sought from the United States, or any State Medicaid program, including, but not limited to, payments sought in any cost reports, cost statements, information reports, or payment requests already submitted by the Debtors or any of their current subsidiaries or affiliates, and shall request, and agree, that such cost reports, cost statements, information reports, or payment requests, even if already settled, be adjusted to account for the effect of the inclusion of the Unallowable Costs. The Debtors agree that the United States, at a minimum, shall be entitled to recoup from the Debtors any overpayment plus applicable interest and penalties as a result of the inclusion of such Unallowable Costs on previously-submitted cost reports, information reports, cost statements, or requests for payment. Any payments due after the adjustments have been made shall be paid to the United States pursuant to the direction of the Department of Justice and/or the affected agencies. The United States reserves its rights to disagree with any calculations submitted by the Debtors or any of their current subsidiaries or affiliates on the effect of inclusion of Unallowable Costs (as defined in this Paragraph) on the Debtors or any of their current subsidiaries or affiliates’ cost reports, cost statements, or information reports.

  • Education Reimbursement The County will provide education reimbursement for education costs incurred by regular employees who apply for such reimbursement in accordance with the policies and procedures governing the education reimbursement program. The maximum reimbursement shall be $1,500 per year.

  • Compensation and Expense Reimbursement A. Client will pay the Company, as compensation for the services provided for in this Agreement and as reimbursement for expenses incurred by Company on Client's behalf, in the manner set forth in Schedule A annexed to this Agreement which Schedule is incorporated herein by reference.

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