Common use of Reciprocity Agreements Clause in Contracts

Reciprocity Agreements. Provider shall cooperate with Health Plan’s Participating Providers and affiliates of Health Plan and agrees to provide Covered Services to Members enrolled in various government sponsored health programs and other health products, and various government sponsored health programs and other health products of affiliates, and to assure reciprocity of health care services. Without limiting the foregoing, if any Member receives services or treatment constituting Covered Services from Provider and a capitated Participating Provider is financially responsible for such services, such Participating Provider shall be solely responsible for compensating Provider for any Covered Services provided by the Provider in accordance with the applicable Payments which are the Responsibility of a Capitated Provider provisions of this Agreement. Payment by the Participating Provider shall be at; (i) the rates agreed by the Participating Provider and Provider, or (ii) if there is no applicable agreement, at the lesser of Provider’s billed charges or an amount equivalent to one hundred percent (100%) of the governing rates provided by applicable State and Federal Law specific to the Member's enrolled benefit plan (i.e. Medicaid, Medicare, etc) in place at the time services are rendered, or (iii) at the election of the Participating Provider, at the rates set forth in this Agreement. Provider agrees that the applicable provisions of the Compensation section of this Agreement shall continue to be binding upon Provider, especially in that Provider shall not balance xxxx Members for any Covered Services. Provider shall comply with the procedures established by Health Plan or its affiliates and this Agreement for reimbursement of such services or treatment. Provider shall not encourage Members to receive Covered Services from non-Participating Providers. Breach of this section shall constitute breach of a material term of the Agreement and will give rise to cause for termination of this Agreement pursuant to the applicable Termination with Cause provisions of this Agreement. Provider shall abide by all representative’s initials: FB provisions of this Agreement relating to non-billing of Members with respect to all services and treatment subject to this reciprocity arrangement.

Reciprocity Agreements. Provider shall Hospital will cooperate with Health Plan’s Participating Providers and affiliates of Health Plan and agrees to provide Covered Hospital Services to Members enrolled in various government sponsored health programs Government Programs and other health products, and various government sponsored health programs and other health products of affiliates, and to assure reciprocity of health care services. Without limiting the foregoing, if any Member receives services or treatment constituting Covered Hospital Services from Provider Hospital and a capitated Participating Provider is financially responsible for such services, such Participating Provider shall will be solely responsible for compensating Provider Hospital for any Covered Hospital Services provided by the Provider Hospital in accordance with the applicable Section 2.10.f (Payments which are the Responsibility of a Capitated Provider provisions of this AgreementProvider). Payment by the Participating Provider shall will be at; (i) the rates agreed by the Participating Provider and ProviderHospital, or (ii) if there is no applicable agreement, at the lesser of Provider’s billed charges or an amount equivalent to one hundred percent (100%) of the governing rates provided by applicable State and Federal Law specific to the Member's enrolled benefit plan (i.e. Medicaid, Medicare, etc) in place at the time services are rendered, or (iii) at the election of the Participating Provider, at the rates set forth in this Agreement. Provider Hospital agrees that the applicable provisions of the Compensation section of this Agreement shall Section 2.10.b (Compensation) will continue to be binding upon ProviderHospital, especially in that Provider shall Hospital will not balance xxxx bill Members for any Covered Hospital Services. Provider shall Hospital will comply with the procedures established by Health Plan or its affiliates and this Agreement for reimbursement of such services or treatment. Provider shall Hospital will not encourage Members to receive Covered Hospital Services from non-Participating Providers. Breach of this section shall will constitute breach of a material term of the Agreement and will give rise to cause for termination of this Agreement pursuant to the applicable Section 4.3 (Termination with Cause provisions of this AgreementCause). Provider shall Hospital will abide by all representative’s initials: FB provisions of this Agreement relating to non-billing of Members with respect to all services and treatment subject to this reciprocity arrangement.

Reciprocity Agreements. Provider shall will cooperate with Health Plan’s Participating Providers and affiliates of Health Plan and agrees to provide Covered Provider Services to Members enrolled in various government sponsored health programs Government Programs and other health products, and various government sponsored health programs and other health products of affiliates, and to assure reciprocity of health care services. Without limiting the foregoing, if any Member receives services or treatment constituting Covered Provider Services from Provider and a capitated Participating Provider is financially responsible for such services, such Participating Provider shall will be solely responsible for compensating Provider for any Covered Provider Services provided by the Provider in accordance with the applicable Section 2.9.h (Payments which are the Responsibility of a Capitated Provider provisions of this AgreementProvider). Payment by the Participating Provider shall will be at; (i) the rates agreed by the Participating Provider and Provider, or (ii) if there is no applicable agreement, at the lesser of Provider’s billed charges or an amount equivalent to one hundred percent (100%) of the governing rates provided by applicable State and Federal Law specific to the Member's enrolled benefit plan (i.e. Medicaid, Medicare, etc) in place at the time services are rendered, or (iii) at the election of the Participating Provider, at the rates set forth in this Agreement. Provider agrees that the applicable provisions of the Compensation section of this Agreement shall Section 2.9.b (Compensation) will continue to be binding upon Provider, especially in that Provider shall will not balance xxxx Members for any Covered Provider Services. Provider shall will comply with the procedures established by Health Plan or its affiliates and this Agreement for reimbursement of such services or treatment. Provider shall will not encourage Members to receive Covered Provider Services from non-Participating Providers. Breach of this section shall will constitute breach of a material term of the Agreement and will give rise to cause for termination of this Agreement pursuant to the applicable Section 4.3 (Termination with Cause provisions of this AgreementCause). Provider shall will abide by all representative’s initials: FB provisions of this Agreement relating to non-billing of Members with respect to all services and treatment subject to this reciprocity arrangement.

Reciprocity Agreements. Provider shall cooperate with Health Plan’s Participating Providers and affiliates of Health Plan and agrees to provide Covered Services to Members enrolled in various government sponsored health programs and other health products, and various government sponsored health programs and other health products of affiliates, and to assure reciprocity of health care services. Without limiting the foregoing, if any Member receives services or treatment constituting Covered Services from Provider and a capitated Participating Provider is financially responsible for such services, such Participating Provider shall be solely responsible for compensating Provider for any Covered Services provided by the Provider in accordance with the applicable Payments which are the Responsibility of a Capitated Provider provisions of this Agreement. Payment by the Participating Provider shall be at; (i) the rates agreed by the Participating Provider and Provider, or (ii) if there is no applicable agreement, at the lesser of Provider’s billed charges or an amount equivalent to one hundred percent (100%) of the governing rates provided by applicable State and Federal Law specific to the Member's ’s enrolled benefit plan (i.e. Medicaid, Medicare, etc) in place at the time services are rendered, or (iii) at the election of the Participating Provider, at the rates set forth in this Agreement. Provider agrees that the applicable provisions of the Compensation section of this Agreement shall continue to be binding upon Provider, especially in that Provider shall not balance xxxx Members for any Covered Services. Provider shall comply with the procedures established by Health Plan or its affiliates and this Agreement for reimbursement of such services or treatment. Provider shall not encourage Members to receive Covered Services from non-Participating Providers. Breach of this section shall constitute breach of a material term of the Agreement and will give rise to cause for termination of this Agreement pursuant to the applicable Termination with Cause provisions of this Agreement. Provider shall abide by all representative’s initials: FB provisions of this Agreement relating to non-billing of Members with respect to all services and treatment subject to this reciprocity arrangement.

Reciprocity Agreements. Provider shall Hospital will cooperate with Health Plan’s Participating Providers and affiliates of Health Plan and agrees to provide Covered Hospital Services to Members enrolled in various government sponsored health programs Government Programs and other health products, and various government sponsored health programs and other health products of affiliates, and to assure reciprocity of health care services. Without limiting the foregoing, if any Member receives services or treatment constituting Covered Hospital Services from Provider Hospital and a capitated Participating Provider is financially responsible for such services, such Participating Provider shall will be solely responsible for compensating Provider Hospital for any Covered Hospital Services provided by the Provider Hospital in accordance with the applicable Section 2.10.f (Payments which are the Responsibility of a Capitated Provider provisions of this AgreementProvider). Payment by the Participating Provider shall will be at; (i) the rates agreed by the Participating Provider and ProviderHospital, or (ii) if there is no applicable agreement, at the lesser of Provider’s billed charges or an amount equivalent to one hundred percent (100%) of the governing rates provided by applicable State and Federal Law specific to the Member's enrolled benefit plan (i.e. Medicaid, Medicare, etc) in place at the time services are rendered, or (iii) at the election of the Participating Provider, at the rates set forth in this Agreement. Provider Hospital agrees that the applicable provisions of the Compensation section of this Agreement shall Section 2.10.b (Compensation) will continue to be binding upon ProviderHospital, especially in that Provider shall Hospital will not balance xxxx Members for any Covered Hospital Services. Provider shall Hospital will comply with the procedures established by Health Plan or its affiliates and this Agreement for reimbursement of such services or treatment. Provider shall Hospital will not encourage Members to receive Covered Hospital Services from non-Participating Providers. Breach of this section shall will constitute breach of a material term of the Agreement and will give rise to cause for termination of this Agreement pursuant to the applicable Section 4.3 (Termination with Cause provisions of this AgreementCause). Provider shall Hospital will abide by all representative’s initials: FB provisions of this Agreement relating to non-billing of Members with respect to all services and treatment subject to this reciprocity arrangement.