Dual Eligible Covered Persons. Provider agrees that in no event, including but not limited to, non-payment by the State Medicaid agency or other applicable regulatory authority, other State source, or breach by Subcontractor of the Agreement, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against any Dual Eligible Covered Person, person acting on behalf of the Dual Eligible Covered Person, or Subcontractor or Health Plan (unless notified otherwise) for Medicare Part A and B Cost Sharing. Instead, Provider will either: (a) accept payment made by or on behalf of Subcontractor as payment in full; or
Dual Eligible Covered Persons. Provider agrees that in no event, including but not limited to, non-payment by the State Medicaid agency or other applicable regulatory authority, other State source, or breach by Subcontractor of the Agreement, shall Provider bill, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against any Dual Eligible Covered Person, person acting on behalf of the Dual Eligible Covered Person, or Subcontractor or Health Plan (unless notified otherwise) for Medicare Part A and B Cost Sharing. Instead, Provider will UHC/PRO.ST.PROG..XXXXXX.00.00.XX UnitedHealthcare Confidential and Proprietary either: (a) accept payment made by or on behalf of Subcontractor as payment in full; or
Dual Eligible Covered Persons. Provider shall not charge Covered Persons who are dually eligible for Medicare and Medicaid for Covered Services. Provider shall identify third-party liability coverage, including Medicare and long-term care insurance, as applicable, and seek third-party liability payments before submitting claims to Health Plan. Attachment A: Medicaid COMPENSATION SCHEDULE FACILITY SERVICES BEHAVIORAL HEALTH Mental Health Crisis Center Of Lancaster County This compensation schedule (“Compensation Schedule”) sets forth the maximum reimbursement amounts for Covered Services provided by Contracted Providers to Covered Persons enrolled in a Medicaid Product. Where the Contracted Provider’s tax identification number (“TIN”) has been designated by the Payor as subject to this Compensation Schedule, Payor shall pay or arrange for payment of a Clean Claim for Covered Services rendered by the Contracted Provider according to the terms of, and subject to the requirements set forth in, the Agreement and this Compensation Schedule. Payment under this Compensation Schedule shall consist of the Allowed Amount as set forth herein less all applicable Cost-Sharing Amounts. All capitalized terms used in this Compensation Schedule shall have the meanings set forth in the Agreement, the applicable Product Attachment, or the Definitions section set forth at the end of this Compensation Schedule.
Dual Eligible Covered Persons. Covered Persons eligible for both Medicare and Medicaid will not be held liable for Medicare Part A and B cost sharing when the State is responsible for paying such amounts. Provider may not impose cost-sharing that exceeds the amount of cost-sharing that would be permitted with respect to the individual under Title XIX if the individual were not enrolled in such a plan. Providers will: (1) accept the Plan payment under the terms of the Agreement as payment in full, or (2) xxxx the appropriate State source. [42 C.F.R. §§ 422.504(i)(3)(i) and 422.504(g)(1)(i)]
