Claims Determination definition

Claims Determination as used in this Agreement means the acknowledgement, adjudication, adjustment, denial, contest, payment, and/or any other action by Health Plan following Provider’s submission of a claim for reimbursement under this Agreement, including without limitation Health Plan’s failure to pay or otherwise take required action with respect to such claims.
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Claims Determination as used in this Agreement means the acknowledgement, adjudication, adjustment, denial, contest, payment, and/or any other action by Blue Shield following Provider’s submission of a claim for reimbursement under this Agreement, including without limitation Blue Shield’s failure to pay or otherwise take required action with respect to such claims.
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Claims Determination means, with respect to a claim by Buyer for payment or indemnification under the Purchase Agreement, (x) a written compromise or settlement of such claim signed by Buyer and the Shareholders specifying an amount owing, if any, to Buyer, (y) a Final Order in favor of Buyer and against one or more of the Shareholders with respect to such claim, or (z) a Final Order in favor of one or more of the Shareholders and against Buyer with respect to such claim.
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Examples of Claims Determination in a sentence

  • Deed Company Claims shall be dealt with for all purposes in accordance with Clause 6 (Claims Determination Process) of the LTD DOCA and any related provisions of that DOCA notwithstanding that those claims are against the Deed Company, not LTD.

  • For the avoidance of doubt, any assessment, decision or action undertaken by the Deed Administrators in connection with the Claims Determination Process will not constitute an assessment, decision or action of the Administrators, the Related Administrators or the Related Deed Administrators.

  • The parties agree that the terms and conditions set forth in this Section 8.1 shall apply to all disputes relating to or arising out of a Claims Determination.

  • The parties further acknowledge and agree that this Section 8.4 shall not apply to controversies or disagreements that arise out of or relate to a Claims Determination, or to Claims Overpayments, or to Final Claims Overpayment Determinations, or to any claims of medical malpractice, breach of privacy or HIPAA obligations, or intellectual property claims.

  • If Provider desires to dispute a Claims Determination, it shall submit a written appeal that contains all of the information set forth in the applicable Provider Manual (“Provider Appeal”) and is completed by Provider pursuant to the timelines and procedural requirements delineated in the Provider Manual.

  • An election to terminate under this section must be exercised, if at all, no later than thirty (30) days after the Claims Determination Deadline.

  • For each Prevailing Claimant who is delinquent in payment on a FSA loan, USDA will offer an additional round of loan servicing to each such claimant within 120 days of (a) the Claims Determination, or (b) the distribution of a Debt Relief Award to each such claimant, whichever date is later.

  • The Settlement Administrator shall issue the Claims Determination Notice within ninety (90) days after the Reimbursement Deadline.

  • Defendant shall then cause funds to be deposited into the Settlement Administration Account for the Cash Payment of Valid Claims within forty-five (45) days of receiving the Claims Determination Notice or within thirty (30) days of the Effective Date, whichever is later.

  • Please refer to the Claims Determination Procedures/Complaints and Appeals section of this Certificate.


More Definitions of Claims Determination

Claims Determination means either, (i) the Escrow Agent shall have received a final and non-appealable order of a court of competent jurisdiction or a final written award of arbitrators as to the disposition of the Claim Amount in the Indemnity Claim Notice, or (ii) the Escrow Agent has received written notice prepared in accordance with Section 4(f) hereof signed by Authorized Representatives of the Representative and the Buyer as to the disposition of the Claim Amount set forth in the Indemnity Claim Notice, at which time (and in any event within one Business Day after receipt of such joint written instructions or final court order and award and accompanying certification) the Escrow Agent shall release to the Buyer or retain, as applicable, such Claim Amount in accordance with such written notice or final court order or award.
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Related to Claims Determination

  • Expert Determination the process described in Paragraph 6 of Schedule 8.3 (Dispute Resolution Procedure);

  • Claim Determination Period means a calendar year. However, it does not include any part of a year during which a person has no coverage under This Plan, or any part of a year before the date this COB provision or a similar provision takes effect.

  • Self-Determination means a philosophy and process by which individuals with developmental disabilities are empowered to gain control over the selection of support services that meet their needs. The basic principles of self-determination are:

  • Adverse Benefit Determination means any of the following:

  • Administrative merits determination means certain notices or findings of labor law violations issued by an enforcement agency following an investigation. An administrative merits determination may be final or be subject to appeal or further review. To determine whether a particular notice or finding is covered by this definition, it is necessary to consult section II.B. in the DOL Guidance.