Timely Provider Payments Sample Clauses

Timely Provider Payments. 1. The Contractor must make timely payments to its providers. The Contractor must ensure that 90% of payment claims from physicians who are in individual or group practice, which can be processed without obtaining additional information from the physician or from a third party, will be paid within 30 days of the date of receipt of the claim. In addition, 99% of all claims from Covered Service providers will be paid within 90 days from the date the Contractor receives the claim. The Contractor and its providers may by mutual agreement, in writing, establish an alternative payment schedule. Generally, the date receipt is the date the agency receives the claim, as indicated by its date stamp on the claim. The date of payment is the date of the check or other form of payment.
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Timely Provider Payments. The Contractor must make timely payments to Providers. The Contractor must ensure that ninety percent (90%) of payment claims from physicians who are in individual or group practice, which can be processed without obtaining additional information from the physician or from a Third Party (hereinafter “Clean Claim”), from Providers for Covered Services will be paid within thirty (30) days after the date of receipt of the claim. The Contractor must ensure that ninety-nine percent (99%) of Clean Claims from Providers for Covered Services will be paid within ninety (90) days after the date of receipt of the claim. The Contractor and its Providers may by mutual agreement, in writing, establish an alternative payment schedule provided that payment is no less timely than provided in this Section 5.1.9.
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Timely Provider Payments. 5.1.9.1. The Contractor must make timely payments to its providers. The Contractor must ensure that ninety percent (90%) of claims from physicians who are in individual or group practice, which can be processed without obtaining additional information from the physician or from a third party, will be paid within thirty (30) days of the date of receipt of the claim. In addition, ninety-nine percent (99%) of all clean claims from Covered Service providers will be paid within ninety (90) days of the date of receipt of the claim. The Contractor and its providers may by mutual agreement, in writing, establish an alternative payment schedule. Generally, the date of receipt is the date the agency receives the claim, as indicated by its date stamp on the claim. The date of payment is the date of the check or other form of payment.
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Timely Provider Payments. The Contractor must make timely payments to its Network Providers consistent with 42 C.F.R. § 447.45. The Contractor must ensure that ninety percent (90%) of claims from Network Providers (including Indian Health Care Providers) who are in individual or group practice, which can be processed without obtaining additional information from the physician or from a third party, will be paid within thirty (30) days of the date of receipt of the claim. In addition, ninety-nine percent (99%) of all clean claims from Network Providers will be paid within ninety (90) days of the date of receipt of the claim. The Contractor and its Network Providers may by mutual agreement, in writing, establish an alternative payment schedule. Generally, the date of receipt is the date the agency receives the claim, as indicated by its date stamp on the claim. The date of payment is the date of the check or other form of payment.
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Timely Provider Payments. 5.1.9.1. The ICO must make timely payments to its providers. The ICO must include a prompt payment provision in its contracts with providers and suppliers, the terms of which are developed and agreed to by both the ICO and the relevant provider. The ICO must ensure that ninety percent (90%) of payment Claims, which can be processed without obtaining additional information from the physician or from a third party ( a “Clean Claim”), from physicians who are in individual or group practice will be paid within ninety (90) calendar days of the date of receipt of the Claim. Claims from LTSS providers will be paid within 30 (thirty) calendar days of the date of receipt of the “clean claim.” The ICO and its providers may by mutual agreement, in writing, establish an alternative payment schedule.
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Timely Provider Payments. The plan shall comply with the provider payment provisions pursuant to this contract.
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Timely Provider Payments. 5.1.9.1. As defined in 42 C.F.R. § 447.46, the FIDA Plan pays all clean electronic claims within thirty (30) days of receipt and paper claims within forty-five (45) days per NYS Insurance Law Section 3224a.
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Timely Provider Payments. The ICO must make timely payments to its providers, including Indian Health Care Providers. The ICO must include a prompt payment provision in its contracts with providers, including Indian Health Care Providers and suppliers, the terms of which are developed and agreed to by both the ICO and the relevant provider. The ICO must ensure that ninety percent (90%) of payment Claims, which can be processed without obtaining additional information from the physician or from a third party ( a “Clean Claim”), from physicians who are in individual or group practice will be paid within ninety (90) calendar days of the date of receipt of the Claim. Claims from LTSS providers will be paid within thirty (30) calendar days of the date of receipt of the “clean Claim” or other form of itemized Claim including a paper or electronic invoice or receipt for services or a service/work log. The ICO and its providers, including Indian Health Care Providers, may by mutual agreement, in writing, establish an alternative payment schedule. The ICO must make timely payments to all providers for covered services rendered to Enrollees as required by MCL 400.111i and in compliance with any established MDHHS performance standards. The ICO is not responsible for any payments owed to providers for services rendered prior to a Potential Enrollee's Enrollment with the ICO’s plan. Payment for services provided during a period of retroactive Medicaid eligibility will be the responsibility of MDHHS unless the services were delivered during an active MI Health Link deeming period. The ICO is responsible for annual IRS form 1099, Reporting of Provider Earnings, and must make all collected data available to MDHHS and, upon request, to CMS. Total Payment: The ICO or its providers may not require any co-payments or other cost-sharing arrangements. The ICO providers must not bill Enrollees for the difference between the provider’s charge and the ICO’s payment for Covered Services. The ICO’s providers must not seek nor accept additional or supplemental payment from the Enrollee, their family, or representative, in addition to the amount paid by the ICO even when the Enrollee signed an agreement to do so. These provisions also apply to out-of-network providers. Protection of Enrollee-Provider Communications In accordance with 42 USC §1396 u-2(b)(3), the ICO shall not prohibit or otherwise restrict a provider or clinical First Tier, Downstream, or Related Entity of the ICO from advi...
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Timely Provider Payments. 5.1.9.1. In accordance with 42 C.F.R. § 447.46, the ICDS Plan must pay ninety percent (90%) of all submitted Clean Claims within thirty (30) days of the date of receipt and ninety-nine percent (99%) of such claims within ninety (90) days of the date of receipt, unless the ICDS Plan and its contracted Provider(s) have established an alternative payment schedule that is mutually agreed upon and described in their contract.
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Related to Timely Provider Payments

  • Volunteer Payments You must not, except at your own cost, voluntarily make any payments, assume any obligations, or incur any other expenses except first aid to others at the time of bodily injury.

  • Other payments You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. “Other payments” include payments made in the course of the requester’s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations).

  • Child Support Payments Child Support payments for the Children Outside the Couple shall be made by the ☐ Husband ☐ Wife to the ☐ Husband ☐ Wife in payments of $ due each month commencing on the 1st of the month following a petition for Divorce being filed in the jurisdiction of Governing Law (“Child Support”). Child Support shall continue until the first of the following events:

  • Netting of Payments Subparagraph (ii) of Section 2(c) of this Agreement will apply to Transactions entered into under this Agreement unless otherwise specified in a Confirmation.

  • OTHER PAYMENT REQUIREMENTS No payment is due for leave days, for days in which treatment is not provided, or for days on which the patient is absent from treatment (whether excused or unexcused).

  • CLAIM FILING AND PROVIDER PAYMENTS This section provides information regarding how a member may file a claim for a covered healthcare service and how we pay providers for a covered healthcare service. How to File a Claim Network providers file claims on your behalf. Non-network providers may or may not file claims on your behalf. If a non-network provider does not file a claim on your behalf, you will need to file it yourself. To file a claim, please send us the provider’s itemized bill, and include the following information: • your name; • your member ID number; • the name, address, and telephone number of the provider who performed the service; • date and description of the service; and • charge for that service. Please send your claim to the address listed in the Contact Information section. Claims must be filed within one calendar year of the date you receive a covered healthcare service. Claims submitted after this deadline are not eligible for reimbursement. This timeframe does not apply if you are legally incapacitated. How Network Providers Are Paid We pay network providers directly for covered healthcare services. Network providers agree not to bill, charge, collect a deposit from, or seek reimbursement from you for a covered healthcare service, except for your share under the plan. When you see a network provider, you are responsible for a share of the cost of covered healthcare services. Your share includes the deductible, if one applies, and the copayment, as listed in the Summary of Medical Benefits. The covered healthcare service may also have a benefit limit, which caps the amount we will reimburse the provider for that service. You will be responsible for any amount over the benefit limit, up to the allowance. Your provider may request these payments at the time of service, or may bill you after the service. If you do not pay your provider, the provider may decline to provide current or future services or may pursue payment from you, such as beginning collection proceedings. Some of our agreements with network providers include alternative payment methods such as incentives, risk-sharing, care coordination, value-based, capitation or similar payment methods. Your copayments are determined based on our allowance at the date the service is rendered. Your copayment may be more or less than the amount the network provider receives under these alternative payment methods. Your copayment will not be adjusted based on these alternative payment methods, or for any payment that is not calculated on an individual claim basis. Our contracts with providers may establish a payment allowance for multiple covered healthcare services, and we may apply a single copayment based on these arrangements. In these cases, you will typically be responsible for fewer copayments than if your share of the cost had been determined on a per service basis.

  • Grant Payments All grant payments are requested by submitting a Grant Payment Request. Payment Requests and supporting documentation must be submitted on the DOS Grants System at xxxxxxxxx.xxx. The total grant award shall not exceed $[award], which shall be paid by the Division in consideration for the Grantee’s minimum performance as set forth by the terms and conditions of this Agreement. The grant payment schedule is outlined below:

  • Check-Off Payments The Employer shall deduct from every employee any dues, initiation fees, or assessments levied by the Union on its members.

  • Service Provider Obligations Service Provider shall:

  • Obligations of Business Associate Upon Termination Upon termination of this Agreement for any reason, business associate shall return to covered entity or, if agreed to by covered entity, destroy all protected health information received from covered entity, or created, maintained, or received by business associate on behalf of covered entity, that the business associate still maintains in any form. Business associate shall retain no copies of the protected health information.

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