Services Received definition
Examples of Services Received in a sentence
FOR DEPARTMENT USE ONLY Date Invoice Received: Date Goods and Services Received: Services From: Services To: OCA AMOUNT Invoice Type: Date Goods and Services were Approved: Approved for Payment By: Regular (Signature of Agency Official) Date CONTRACT MANAGER Invoice Nbr.
Dental Services Received from a: • Dental or medical department maintained for employees by or on behalf of an employer; or • Mutual benefit association, labor union, trustee or similar person or group.
REQUEST FOR PAYMENT Contract : Payment Method: Line Item Rate Budget Unit Expenditures YTD Expenditures Balance $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - $ - Date Invoice Received: Date Goods and Services Received: Services From: Services To: OCA AMOUNT Invoice Type: Date Goods and Services w ere Approved: Approved for Payment By: (Signature of Agency Official) Date CONTRACT MANAGER Invoice Nbr.
The Project Officer shall complete and sign Form NIH-2345, Report of Rental Equipment and Services Received (or similar form/memorandum) and forward the original to NIEHS Procurement Support promptly at the conclusion of each payment period.
Notice of Claim 106 Claim Forms 106 In-Network Practitioners/Providers 106 Out-of-Network Practitioners/Providers 107 Procedure for Reimbursement 107 Services Received Outside the United States 108 Claim Fraud 108 Effects of Other Coverage 109 This Section explains how we will coordinate benefits hsould you have medical coverage through another group Health Benefits Plan.
Notice of Claim 107 Claim Forms 107 In-network Practitioners/Providers 107 Out-of-network Practitioners/Providers 108 Procedure for Reimbursement 108 Services Received Outside the United States 109 Claim Fraud 109 Effects of Other Coverage 110 This Section explains how we will coordinate benefits hsould you have medical coverage through another group Health Benefits Plan.
Ancillary Services Received Out-of-State If the provider submitting a non-emergent laboratory, DME/medical supply, and/or specialty pharmacy claim has a PPO contract with BCBSAZ or one or more out-of-state Blue Cross and/or Blue Shield plans, but does not have a PPO contract with the Blue Cross and/or Blue Shield plan to which the claim must be submitted under Blue Cross and Blue Shield Association requirements, those claims will be processed based on the selection made in the column at right.
Notice of Claim 105 Claim Forms 105 In-network Practitioners/Providers 105 Out-of-network (outside of the 5-county area) Practitioners/Providers 106 Procedure for Reimbursement 106 Services Received Outside the United States 107 Claim Fraud 107 Effects of Other Coverage 108 This Section explains how we will coordinate benefits hsould you have medical coverage through another group Health Benefits Plan.
Notice of Claim 105 Claim Forms 105 In-Network Practitioners/Providers 105 Out-of-Network Practitioners/Providers 106 Procedure for Reimbursement 106 Services Received Outside the United States 107 Claim Fraud 107 Effects of Other Coverage 108 This Section explains how we will coordinate benefits hsould you have medical coverage through another group Health Benefits Plan.
Notice of Claim 116 Claim Forms 116 In-network Practitioners/Providers 117 Out-of-network Practitioners/Providers 117 Procedure for Reimbursement 117 Services Received Outside the United States 118 Claim Fraud 118 Indemnity 118 This Section explains how we will coordinate benefits should you have medical coverage through another group Health benefits Plan.