Request for Reinsurance Reimbursement Form definition
Request for Reinsurance Reimbursement Form means a form substantially similar to Attachment F, provided to the Plan by the Reinsurer and all back-up information and supporting documentation required by Reinsurer and provided by the Plan including but not limited to: a fully completed Request for Reinsurance Reimbursement Form; dates of service; dates of payment; amount paid with draft or check numbers with listing of all applicable claim valuations (by international classification of diseases (ICD9), diagnostic related group (DRG), or physician current procedural terminology (CPT) codes as defined in Article III - Reinsurance Coverage) and totaled on computer form or calculator tape; copies of universal hospital billing forms (UB92s) and vendor ▇▇▇▇▇▇▇▇; copy of accident report (if applicable), and invoices/▇▇▇▇▇▇▇▇ for case management fees (if applicable), and returned by the Plan to Reinsurer to evidence payment of Losses eligible for reimbursement according to Article III - Reinsurance Coverage.
Request for Reinsurance Reimbursement Form means a form substantially similar to Attachment F, provided to the Plan by the Reinsurer and all back-up information and supporting documentation required by Reinsurer and provided by the Plan including but not limited to: a fully completed Request for Reinsurance Reimbursement Form; dates of service; dates of payment; amount paid with draft or check numbers with listing of all applicable claim valuations (by international classification of diseases (ICD9), diagnostic related group (DRG), or physician current procedural terminology (CPT) codes as defined in Article III - Reinsurance Coverage) and totaled on computer form or calculator tape; copies of universal hospital billing forms (UB92s) and vendor ▇▇▇▇▇▇▇▇; copy of accident report (if applicable), and invoices/▇▇▇▇▇▇▇▇ for case management fees (if applicable), and returned by the Plan to Reinsurer to evidence payment of Losses eligible for reimbursement according to Article III - Reinsurance Coverage. U. "Termination Date" shall mean the date this Agreement shall terminate. Reinsurer shall have no liability for any Loss incurred after that date by Members or the Plan, unless the Agreement is otherwise renewed by the Plan pursuant to Article II Section A -