Multiple Surgeries Sample Clauses

Multiple Surgeries. When a doctor performs more than one procedure in a day, there are rules that may reduce our allowance for the additional procedure. Our allowance may also include post-operative care and other procedures provided within specified time periods.
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Multiple Surgeries. When a doctor performs more than one procedure in a day, there are rules that may reduce our allowance for the additional procedure. Our allowance may also include post-operative care and other procedures provided within specified time periods. If More Than One Surgeon Operates In addition to the type and purpose of surgery, our allowance differs depending on the number of surgeons involved, including assistant surgeons. If two (2) surgeons perform separate operations during a single surgical session, each surgeon may submit a claim reporting the procedure performed and the circumstances involved. These claims will then be evaluated for payment on an individual basis.
Multiple Surgeries. If more than one surgical operation is performed through a single incision or because of the same or related conditions, such multiple surgeries may be regarded as one operation and the benefit applicable under this segment shall be equal to the benefit for that one of the operations for which the largest amount is payable, provided this does not exceed the maximum amount specified in the Schedule of Benefits. If more than one surgical operation is performed on the same person through separate incisions because of unrelated conditions and such conditions result from the same injury, or such operations are performed within a twenty-four (24) hour period, the benefit applicable for such multiple surgeries shall be equal to the benefit for that one of the operations for which the largest amount is payable plus one-half of the benefit provided for each of the other operations, provided this sum does not exceed the maximum amount specified in the Schedule of Benefits. However, if more than one surgical operation is performed on the same person because of unrelated conditions and such operations are separated by a period of more than twenty-four (24) hours, surgical benefits shall be determined for each of the operations individually, subject to the maximum amount specified in the Schedule of Benefits. Also, where more than one surgical operation is performed on the same person and these operations were separated by an interval during which that person completely recovers and resumes full normal activities for at least three (3) months, benefits will be determined for each of the operations individually, even if the operations are performed because of the same or related conditions. SURGICAL OPERATIONS NOT CONTAINED IN THE SCHEDULE OF OPERATIONS. If the operation performed is not shown in the Schedule of Operations, Kaiser reserves the right to determine the amount of Surgeon’s Fee payable for such operation. An operation of comparable or equivalent gravity and severity will be used as a basis for the settlement, but not to exceed the maximum provided under this Contract.
Multiple Surgeries. If more than one surgical operation is performed through a single incision or because of the same or related conditions, such multiple surgeries may be regarded as one operation and the benefit applicable under this segment shall be equal to the benefit for that one of the operations for which the largest amount is payable, provided this does not exceed the maximum amount specified in the Schedule of Benefits. If more than one surgical operation is performed on the same person through separate incisions because of unrelated conditions and such conditions result from the same injury, or such operations are performed within a twenty-four (241 hour period, the benefit applicable for such multiple surgeries shall be equal to the benefit for that one of the operations for which the largest amount is payable plus one-half of the benefit provided for each of the other operations, provided this sum does not exceed the maximum amount specified in the Schedule of Benefits. However. if more than one surgical operation is performed on the same person because of unrelated conditions and such operations are separated by a period of more than twenty-four
Multiple Surgeries. Requirements: QMACS needs to identify and process claims appropriately when multiple procedures are performed on the same date of service, whether such procedures are billed together or separately and with or without the appropriate modifier indicated by the provider of service. QMACS needs to be capable of paying modifier discounts in tiers according to the contracted amount (e.g. 2nd procedure at 50%, 3rd procedure at 25% and so on) by program/line of business. Such functionality may utilize the system global days table which indicates which procedures qualify for multiple surgery. Overview: - A new edit will be created to indicate that multiple surgeries were detected and NOT billed appropriately. - QMACS will evaluate the current claim and all historical claims for the member to find claims for the same date of service with the same provider. - If multiple procedures are found and modifier 51 is not used, fire the new edit. - In addition to firing the new edit, QMACS should apply the 51 modifier to all but the most expensive procedure performed on the same day. - By default, modifier 51 should be added to the least expensive procedure(s). The most expensive procedure is considered primary. However, in the event that a less-expensive procedure has already been paid, the remaining procedures should be changed to reflect the 51 modifier.

Related to Multiple Surgeries

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  • Multiple Roles The parties expressly acknowledge and consent to Xxxxx Fargo Bank, National Association, acting in the multiple roles of the Indenture Trustee, the Custodian, the Back-Up Servicer and the Successor Servicer. Xxxxx Fargo Bank, National Association may, in such capacities, discharge its separate functions fully, without hindrance or regard to conflict of interest principles, duty of loyalty principles or other breach of fiduciary duties to the extent that any such conflict or breach arises from the performance by Xxxxx Fargo Bank, National Association of express duties set forth in this Indenture in any of such capacities, all of which defenses, claims or assertions are hereby expressly waived by the other parties hereto except in the case of negligence (other than errors in judgment) and willful misconduct by Xxxxx Fargo Bank, National Association.

  • Multiple Closing Dates In the event the Corporation shall issue on more than one date Additional Shares of Common Stock that are a part of one transaction or a series of related transactions and that would result in an adjustment to the Conversion Price of any series of Preferred Stock pursuant to the terms of Subsection 5.4.4, and such issuance dates occur within a period of no more than ninety (90) days from the first such issuance to the final such issuance, then, upon the final such issuance, such Conversion Price shall be readjusted to give effect to all such issuances as if they occurred on the date of the first such issuance (and without giving effect to any additional adjustments as a result of any such subsequent issuances within such period).

  • Multiple Classes We may from time to time provide to you written compliance guidelines or standards relating to the sale or distribution of Funds offering multiple classes of shares (each, a “Class”) with different sales charges and distribution related operating expenses. In addition, you will be bound by any applicable rules or regulations of government agencies or self-regulatory organizations generally affecting the sale or distribution of shares of investment companies offering multiple classes of shares.

  • Components Patheon will purchase and test all Components (with the exception of Client-Supplied Components) at Patheon’s expense and as required by the Specifications.

  • MULTIPLE BUILDINGS If the Premises are part of a group of buildings controlled by Lessor, Lessee agrees that it will abide by, keep and observe all reasonable rules and regulations which Lessor may make from time to time for the management, safety, care, and cleanliness of the grounds, the parking and unloading of vehicles and the preservation of good order, as well as for the convenience of other occupants or tenants of such other buildings and their invitees, and that Lessee will pay its fair share of common expenses incurred in connection therewith.

  • Multiple Options In the event that Lessee has any multiple Options to extend or renew this Lease, a later Option cannot be exercised unless the prior Options have been validly exercised.

  • Multiple Adjustments For the avoidance of doubt, if an event occurs that would trigger an adjustment to the Conversion Rate pursuant to this Section 11 under more than one subsection hereof, such event, to the extent fully taken into account in a single adjustment, shall not result in multiple adjustments hereunder; provided, however, that if more than one subsection of this Section 11 is applicable to a single event, the subsection shall be applied that produces the largest adjustment.

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