Client Eligibility definition

Client Eligibility means an organization that: (i) is an employer, union, third party administrator, insurer, HMO or other health plan sponsor or other entity that issues or administers one or more Plan(s); (ii) offers prescription drug benefits to Members (including MA-PD or PDP plans and Qualified Retiree Prescription Drug (“QRPD”) Plans as defined in 42 C.F.R. § 423.882); (iii) is responsible for 50% or greater of the aggregate annual costs of all Covered Drugs dispensed for all of such entity’s Members; and (iii) is under a written agreement with Client for the provision of formulary and Rebate Services .
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Examples of Client Eligibility in a sentence

  • Ensure compliance with Client Eligibility requirements to include: Texas residence eligibility, financial eligibility and clinical eligibility as specified in SUD UM Guidelines.

  • Ensure compliance with Client Eligibility requirements to include: Texas residence eligibility, Financial Eligibility, and clinical eligibility as specified in SUD Program Guide.

  • Ensure compliance with Client Eligibility requirements to include: Texas residence eligibility, financial eligibility and clinical eligibility as specified in SUD Program Guide.

  • Draw requests will be made such that Federal reimbursements are received by the State based on the daily and monthly reports produced by the Arkansas Client Eligibility System (ACES).

  • A marketing plan to engage local referral sources and provide information to these sources regarding the availability of SUD treatment and the Client Eligibility criteria for admissions.

  • Client Eligibility Participants must have developed an employment action plan with an Employment Counselor.

  • Adult Texas residents who are pregnant women and women with dependent children (including women whose children are in custody of the State) who meet Client Eligibility criteria for HHSC-funded substance use disorder services as set forth in the SUD Program Guide, ▇▇▇▇▇://▇▇▇.▇▇▇▇▇.▇▇▇/doing-business-hhs/provider-portals/behavioral-health-services- providers/substance-use-disorder-service-providers.

  • Texas residents who meet Client Eligibility criteria for System Agency-funded services as stated in the Substance Use Disorder (SUD) Utilization Management (UM) Guidelines (attached as RFA Exhibit O within the Solicitation, Attachment I).

  • Client Eligibility Individuals seeking services for this category shall have an eligibility established in Provide Enterprise.

  • Substance use providers are required to be compliant with the Client Eligibility, Service Records and Documentation, Terms and Conditions by Other Funding Sources, and Reimbursement Rates sections outlined in “Exhibit B”.