Billing Form definition

Billing Form means the document generated by the Department that acts as a prior authorization, contract, and payment mechanism for services.
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Billing Form means the document generated by the Seniors and People with Disabilities Division that acts as a prior authorization, contract, and payment mechanism for services.
Sample 1Sample 2Sample 3

Examples of Billing Form in a sentence

  • Every reasonable effort has been made to ensure the accuracy of the information obtained from the Uniform Claims and Billing Form (UB-82/92/04) data elements.

  • The Parties agree that billing requirements and outputs will be consistent with the Ordering & Billing Form (OBF) and also with Telcordia Technologies Billing Output Specifications (BOS).

  • Credit card payments, including applicable fees, will be accepted for incidental items reflected on the Additional Billing Form only.

  • Any additional fees incurred in connection with or during the Event reflected on the Additional Billing Form shall be due and payable on the day of the Event.

  • The Environmental Protection Agency ("EPA") has selected a remedy for the soil and shallow groundwater ("Operable Unit 1" or OU-1); however, the remedial investigation/feasibility study related to the deep groundwater (OU-2) has not been completed.

  • The Final Event Total may not be determined until the day of the Event whereupon the Additional Billing Form will be finalized to reflect any additional services requested and any additional fees incurred in connection with or during the Event.

  • The record layout for data submittal (see Appendix A-2) follows the Uniform Billing Form (UB-04) data specifications and indicates which elements are required.

  • The final event total is comprised of the sum of the Estimated Event Total and additional fees incurred in connection with the Event as reflected in the Event Order (in the form attached hereto as Addendum B) and the Additional Billing Form (attached hereto as Addendum C) (“Final Event Total”).

  • The DFA-67-A, Burial Billing Form, is completed by the Funeral Home Director and submitted to the Department.

  • A claim submitted by Provider or its agent to Company or its agent using a HCFA 1500 form or a Uniform Billing Form 92 (UB92), as appropriate, or a successor to either of these forms adopted by the National Uniform Billing Committee or its successor.

Related to Billing Form

  • Billing involves the provision of appropriate usage data by one Telecommunications Carrier to another to facilitate Customer Billing with attendant acknowledgments and status reports. It also involves the exchange of information between Telecommunications Carriers to process claims and adjustments.

  • Booking Form means the booking form you completed setting out details of your order in respect of the Event;

  • Invoice means a Contractor’s claim for payment. At the Agency’s discretion, claims may be submitted on an original invoice from the Contractor or may be submitted on a claim form acceptable to the Agency, such as a General Accounting Expenditure (GAX) form.

  • Billing Statement has the meaning assigned to such term in Section 2.18(g).

  • Calling Name Delivery Service (CNDS) means a service that enables a terminating End User to identify the calling Party by a displayed name before a call is answered. The calling Party’s name is retrieved from a calling name database and delivered to the End User’s premise between the first and second ring for display on compatible End User premises equipment.

  • Purchase Order means the form or format a Customer uses to make a purchase under the Contract (e.g., a formal written purchase order, electronic purchase order, procurement card, contract or other authorized means).

  • Billing System means a system to issue Invoices relating to charges payable by each party under an Access Agreement;

  • Freight forwarding services means the activity consisting of organising and monitoring shipment operations on behalf of shippers, through the acquisition of transport and related services, preparation of documentation and provision of business information.

  • Rolling Forecast has the meaning set forth in Section 4.2.

  • Shipment means a volume of products offered to and accepted by Carrier for transportation.

  • Prepaid wireless calling service means a telecommunications service that provides the right to utilize mobile wireless service as well as other non-telecommunications services, including the download of digital products delivered electronically, content and ancillary services, which must be paid for in advance that is sold in predetermined units or dollars of which the number declines with use in a known amount.

  • Detailed telecommunications billing service means an ancillary service of separately stating information pertaining to individual calls on a customer's billing statement.

  • The Purchase Order means the order placed by the Purchaser on the Supplier signed by the Purchaser including all attachments and appendices thereto and all documents incorporated by reference therein. The purchase order shall be deemed as "Contract" appearing in the document.

  • Firm Order shall have the meaning set forth in Section 5.2.

  • Delivery services means those services provided by the

  • Service Order Form means our standard Service Order Form for Services, or any other order form that we agree with you in writing that incorporates the provisions of this DPA;

  • Long Form Notice means the form of notice that shall be posted on the Settlement website created by the Settlement Administrator and shall be available to Settlement Class members by mail on request made to the Settlement Administrator in the form attached as Exhibit 2.

  • Sample means a sample of blood, tissue or other biological material.

  • Account Opening Form means standardized form prescribed by the management Company to be duly filled by the investors at the time of opening an account with the Fund.

  • Claims processing services means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include:

  • Case Report Form means a printed, optical or electronic document or database designed to record all of the information, which is required by the Protocol to be reported to the Sponsor on each Study Participant.

  • Delivery service means the providing of electric transmission or distribution to a retail customer.

  • Customer Service means Company’s customer service telephone service department or representatives.

  • Contract Services means the Services to be supplied by the Supplier to the Customer as set out in the Letter of Appointment;

  • Delivery Schedule means the schedule for the delivery of Services as set forth in attached Annex 3.

  • Catalog means the available list of tangible personal property or services, in the most current listing, regardless of date, during the life of the contract, that takes the form of a catalog, price list, schedule, shelf price or other form that: