For Medicaid Clients Sample Clauses

For Medicaid Clients. All Medicaid covered services are to be billed to the Medicaid Managed Care entity in which the child is enrolled, in accordance with the rules and regulations of said organization. Enrollment in Medicaid Managed Care Organizations: All Providers must attempt to enroll with all Medicaid Managed Care programs in their region prior to providing any services and providers will submit to H.P.C. documentation of the attempts to enroll if unsuccessful. Providers may choose to enroll under the MMA plan contract with HPC when that option is available. Please indicate your enrollment decisions on the form Third Party Insurance Participation Status (attachment 8). Out of network commercial insurance billing: The Provider will submit documentation to H.P.C. with the monthly invoice, of attempts to authorize services and enroll with a child’s third party insurance carrier or within 30 days of the date of authorization of services on the child’s IFSP. With the following exceptions: ITDS and BCBS: If you are enrolled as an ITDS you do not have to attempt to enroll with or submit out-of-network billing to Blue Cross and Blue Shield. HPC has retained documentation that they will not accept claims from Independent ITDS providers. Submitting out of network billing: Providers will submit billing to Medicaid Managed Care plans and third party insurance as out of network providers if they are unable to enroll in the network. Submission of claims: The provider agrees to bill any identified third party payer within sixty (60) days of date of service according to the terms and conditions of said payer source. Natural Environment Support Fee: The Provider will only bill for the Natural Environment Support Fee (NESF) when an authorized service is provided in the natural environment. Travel Requirements: Travel claims will be paid in accordance with the Department of Financial Services Travel Manual. The Provider must maintain and submit evidence of a valid State of Florida motor vehicle operator license and valid automotive insurance (declaration page). Updated copies of these documents MUST be submitted to H.P.C. as soon as they are received, any break in valid coverage will result in a suspension of the Provider’s approval to travel to provide services. Travel reimbursement claims must be submitted on a signed state travel voucher (located on the HPC website).
Sample 1
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For Medicaid Clients. All Medicaid covered services are to be billed to the Medicaid Managed Care entity in which the child is enrolled, in accordance with the rules and regulations of said organization. Enrollment in Medicaid Managed Care Organizations: All Providers must attempt to enroll with all Medicaid Managed Care programs in their region prior to providing any services and providers will submit to H.P.C. documentation of the attempts to enroll if unsuccessful. Providers may choose to enroll under the MMA plan contract with HPC when that option is available. Please indicate your enrollment decisions on the form Third Party Insurance Participation Status (attachment 8). Out of network commercial insurance billing: The Provider will submit documentation to H.P.C. with the monthly invoice, of attempts to authorize services and enroll with a child’s third party insurance carrier or within 30 days of the date of authorization of services on the child’s IFSP. With the following exceptions: Submitting out of network billing: Providers will submit billing to Medicaid Managed Care plans and third party insurance as out of network providers if they are unable to enroll in the network.
Sample 1Sample 2
For Medicaid Clients. All Medicaid covered services are to be billed to the Medicaid Managed Care entity in which the child is enrolled, in accordance with the rules and regulations of said organization. Enrollment in Medicaid Managed Care Organizations: All Providers must attempt to enroll with all Medicaid Managed Care programs in their region prior to providing services and providers will submit to H.P.C. documentation of the attempts to enroll if unsuccessful. Providers may choose to enroll under the MMA plan contract with HPC when that option is available. Please indicate your enrollment decisions on the form Third Party Insurance Participation Status (attachment 11). Out of network billing: Providers will submit billing to Medicaid Managed Care plans and third party insurance as out of network providers if they are unable to enroll in the network. Submission of billing within 60 days: The Provider agrees to bill any identified third party payer within sixty (60) days of date of service according to the terms and conditions of said payer source, and to report the intervention to H.P.C. on the Service Log (attachment 7). Natural Environment Support Fee: The Provider will only bill for the Natural Environment Support Fee (NESF) when an authorized service is provided in the natural environment. Minimizing travel: The Provider will make every effort to group clients together to avoid multiple trips to and from their home/office. When performing multiple evaluations with the team, the team will make all efforts to drive together in one vehicle. Invoice Deadline: The invoice to H.P.C. including the Service Log (attachment 7), the Third Party Denial List (attachment 8), the Travel Voucher (attachment 3) and any third party denials, is due to H.P.C. on the first day of each month. Invoices received after the third of the month will be considered late and payment maybe delayed or held until the end of the fiscal year. Invoices that are received 60 days after the date of service will not be paid. Monthly Service Period: The service period to be submitted with each monthly invoice covers the period from the 16th of a month to the 15th of the following month, giving the Provider two weeks to prepare the documentation for submission.
Sample 1

Related to For Medicaid Clients

  • Subcontracting for Medicaid Services Notwithstanding any permitted subcontracting of services to be performed under this Agreement, Party shall remain responsible for ensuring that this Agreement is fully performed according to its terms, that subcontractor remains in compliance with the terms hereof, and that subcontractor complies with all state and federal laws and regulations relating to the Medicaid program in Vermont. Subcontracts, and any service provider agreements entered into by Party in connection with the performance of this Agreement, must clearly specify in writing the responsibilities of the subcontractor or other service provider and Party must retain the authority to revoke its subcontract or service provider agreement or to impose other sanctions if the performance of the subcontractor or service provider is inadequate or if its performance deviates from any requirement of this Agreement. Party shall make available on request all contracts, subcontracts and service provider agreements between the Party, subcontractors and other service providers to the Agency of Human Services and any of its departments as well as to the Center for Medicare and Medicaid Services.

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Medicaid Program Contractors Inspection of Records: Any contracts accessing payments for services through the Global Commitment to Health Waiver and Vermont Medicaid program must fulfill state and federal legal requirements to enable the Agency of Human Services (AHS), the United States Department of Health and Human Services (DHHS) and the Government Accounting Office (GAO) to: Evaluate through inspection or other means the quality, appropriateness, and timeliness of services performed; and Inspect and audit any financial records of such Contractor or subcontractor.

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S RESOURCES. Services reimbursed under Medicaid are outlined in Attachment “A” to this Agreement. Once a Medicaid application has been submitted on the Resident’s behalf, the Resident, Sponsor, and Resident Representative agree to pay, to the extent they have access to the Resident’s funds, to the Facility the Resident’s monthly income, which will be owed to the Facility under the Resident’s Medicaid budget. Medicaid recipients are required to pay their Net Available Monthly Income (“NAMI”) to the Facility on a monthly basis as a co-payment obligation as part of the Medicaid rate. A Resident’s NAMI equals his or her income (e.g., Social Security, pension, etc.), less allowed deductions. The Facility has no control over the determination of NAMI amounts, and it is the obligation of the Resident, Resident Representative and/or Sponsor to appeal any disputed NAMI calculation with the appropriate government agency. Once Medicaid eligibility is established, the Resident, Resident Representative and/or Sponsor agree to pay NAMI to the Facility or to arrange to have the income redirected by direct deposit to the Facility and to ensure timely Medicaid recertification. The Resident, Sponsor and Resident Representative agree to provide to the Facility copies of any notices (such as requests for information, budget letters, recertification, denials, etc.) they receive from the Department of Social Services related to the Resident’s Medicaid coverage. Until Medicaid is approved, the Facility may bill the Resident’s account as private pay and the Resident will be responsible for the Facility’s private pay rate. If Medicaid denies coverage, the Resident or the Resident’s authorized representative can appeal such denial; however, payment for any uncovered services will be owed to the Facility at the private pay rate pending the appeal determination. If Medicaid eligibility is established and retroactively covers any period for which private payment has been made, the Facility agrees to refund or credit any amount in excess of the NAMI owed during the covered period.

  • Primary Care Clinic Employees and each of their covered dependents must individually elect a primary care clinic within the network of providers offered by the plan administrator chosen by the employee. Employees and their dependents may elect to change clinics within their clinic’s Benefit Level as often as the plan administrator permits and as outlined above.

  • Medicaid Program Parties (applicable to any Party providing services and supports paid for under Vermont’s Medicaid program and Vermont’s Global Commitment to Health Waiver):

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  • Contractor Standards Contractor shall comply with Contractor Standards provisions codified in the SDMC. Contractor understands and agrees that violation of Contractor Standards may be considered a material breach of the Contract and may result in Contract termination, debarment, and other sanctions.

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