Claims Determination definition

Claims Determination as used in this Agreement means the acknowledgement, adjudication, adjustment, denial, contest, payment, and/or any other action by Blue Shield following [Party Title]’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.
Sample 1
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.
Sample 1
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.
Sample 1

Examples of Claims Determination in a sentence

  • If [Party Title] 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.

  • 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.

  • 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.


More Definitions of Claims Determination

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.
Sample 1

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.

  • SOFR Determination Date has the meaning specified in the definition of “Daily Simple SOFR”.

  • SOFR Determination Time means approximately 3:00 p.m. (New York City time) on the immediately following U.S. Government Securities Business Day.

  • Final Determination means the final resolution of liability for any Tax for any taxable period, by or as a result of (a) a final decision, judgment, decree or other order by any court of competent jurisdiction that can no longer be appealed, (b) a final settlement with the IRS, a closing agreement or accepted offer in compromise under Sections 7121 or 7122 of the Code, or a comparable agreement under the Laws of other jurisdictions, which resolves the entire Tax liability for any taxable period, (c) any allowance of a refund or credit in respect of an overpayment of Tax, but only after the expiration of all periods during which such refund or credit may be recovered by the jurisdiction imposing the Tax, or (d) any other final resolution, including by reason of the expiration of the applicable statute of limitations or the execution of a pre-filing agreement with the IRS or other Taxing Authority.

  • Adverse determination shall have the meaning set forth in Section 19.7.

  • Dispute Period shall have the meaning specified in Section 9.3(a).