Compensation to Participating Providers Clause Samples

Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement.
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Compensation to Participating Providers. The TPA agrees to provide and manage a comprehensive provider network in the State of Mississippi that will serve the Plan exclusively, and agrees that the Board will have approval authority for any or all contracted rates and terms of the provider contracts for purposes of assuring that the contracted providers agree to participate in or cooperate with the Plan’s medical management and utilization review programs, health and wellness promotion programs, and all other features and programs of the Plan as appropriate. The TPA’s contracts with participating providers shall include provisions pertaining to the compensation of those providers, as described in the sections below. 1. Each network provider contracted by the TPA shall be entitled to compensation for covered services rendered in an amount not to exceed the TPA’s allowable charge. For DRG or per diem rates, the allowable charge is the lessor of the billed charge, the DRG or per diem rate. Network providers shall neither ▇▇▇▇ nor attempt to collect from the participant, the Plan, the Board, or any third party, any amount in excess of the TPA’s allowable charge for any covered service. 2. The participating hospitals contracted by the TPA shall accept and adhere to the allowable charge for covered hospital services when the Plan is the primary payor. When the Plan is the secondary payor under coordination of benefits rules, the allowable charge shall not apply. 3. Network providers shall be entitled to collect from the participant any deductible, co payment, or co insurance amounts specified by the Plan. 4. Network providers shall be entitled to compensation from the participant for health care services not covered under the Plan, for health care services provided to a participant after the benefits set forth in the Plan have been exhausted, or for health care services which are otherwise excluded under the Plan (including any services for which payment is denied under the Plan’s utilization management program provided that the network provider fully cooperated with the utilization management program up to and including the appeals process). Network providers shall not be entitled to compensation from the participant nor from the Plan for services that are not medically necessary, as determined by the medical management and utilization review vendor or by the claims administrator.
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Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. Vendor shall provide the services described in this Addendum. To the extent required by a regulatory or accreditating agency, (a) the parties shall document to the level of specificity required by applicable government authorities and/or United’s accreditation agencies the activities relating to the services that have been delegated under this Exhibit to Vendor in accordance with the timeframes required; (b) before activities are delegated under this Agreement, United will or has conducted a pre‑assessment audit of Vendor to assess Vendor’s ability to fulfill the terms of this Agreement for any delegated activities; and (c) upon request by United, Vendor shall cooperate and participate, either telephonically or personally, in accreditation and/or state or federal regulatory audits, including interview sessions, related to the delegated activities provided under this Agreement. This section (c) shall survive termination of this Agreement, Exhibit and the delegated activities.
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Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. OHCS PHS - UHCKY AM04 IIPAS Contract ID: 6233-E Optum Contract ID: 00172839.2 Kentucky HEALTH refers to the Section 1115 Demonstration Waiver known as Kentucky Helping to Engage and Achieve Long Term Health (HEALTH). (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. OHCS PHS - UHCKY AM04 IIPAS Contract ID: 6233-E Optum Contract ID: 00172839.2 Kentucky HEALTH refers to the Section 1115 Demonstration Waiver known as Kentucky Helping to Engage and Achieve Long Term Health (HEALTH). ADMINISTRATIVE SERVICES AGREEMENT‌ This Administrative Services Agreement (this “Agreement”), is made as of March 1, 2013 (the “Effective Date”), by and between OptumHealth Care Solutions, Inc. (“Vendor”) and UnitedHealthcare of Kentucky, Ltd. (“United”). For services provided on or after its Effective Date, this Agreement supersedes and replaces any and all other agreements, whether written or oral, between the parties regarding the subject matter contained herein.
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Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. “Appendix”) supplements and is made part of the agreement (the “Agreement”) with Dental Benefits Providers, Inc. (“Subcontractor”).
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Compensation to Participating Providers. (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. VISION SERVICES AGREEMENT‌‌‌ This Vision Services Agreement (this “Agreement”), is entered into as of July 1, 2019 (the “Effective Date”), by and between March Vision Care Group Incorporated (“Vendor”) and UnitedHealthcare of Kentucky, Inc. (“United”). For services provided on or after its Effective Date, this Agreement supersedes and replaces any and all other agreements, whether written or oral, between the parties regarding the subject matter contained herein.
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Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. Attachment 2.10.3 Appendix F - Dental Benefit Providers - Executed Contract This Fifth Amendment to the Dental Services Agreement (this “Amendment”), is entered into as of August 1, 2018 (the “Amendment Effective Date”) by and between Dental Benefit Providers, Inc. (“Vendor”) and UnitedHealthcare of Louisiana, Inc. (“United”).
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Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. NEMT Services Vendor shall provide the services described in this Addendum. To the extent required by a regulatory or accrediting agency,‌‌ (a) the parties shall document to the level of specificity required by applicable government authorities and/or United’s accreditation agencies the activities relating to the services that have been delegated under this Exhibit to Vendor in accordance with the timeframes required; (b) before activities are delegated under this Agreement, United will or has conducted a pre-assessment audit of Vendor to assess Vendor’s ability to fulfill the terms of this Agreement for any delegated activities; and (c) upon request by United, Vendor shall cooperate and participate, either telephonically or personally, in accreditation and/or state or federal regulatory audits, including interview sessions, related to the delegated activities provided under this Agreement. This section (c) shall survive termination of this Agreement, Exhibit and the delegated activities.
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Compensation to Participating Providers. So long as United has delegated Claims Administrative Services to Vendor: (a) For all ASO Benefit Plans, Vendor shall adjudicate and Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the clean claim. (b) For all Full Service Benefit Plans, Vendor shall adjudicate and pay a participating provider clean claim within thirty (30) days of receiving the clean claim or as may be set forth in the Provider Agreement. In the event that United has not delegated Claims Administrative Services to Vendor for a Full Service Benefit Plan, Vendor shall adjudicate claims and be financially responsible for Covered Services; Payor shall pay a Participating Provider clean claim within thirty (30) days of receiving the claim based on adjudication by Vendor. UBH- UHCKY AM08 IIPAS Contract ID:6087-H Optum Contract ID: 00172840.3 4 BEHAVIORAL HEALTH SERVICES AGREEMENT‌ This Administrative Services Agreement (this “Agreement”), is made as of March 01, 2012 (the “Effective Date”), by and between United Behavioral Health and its subsidiaries (“Vendor”) and UnitedHealthcare of Kentucky, Ltd. (“United”). For services provided on or after its Effective Date, this Agreement supersedes and replaces any and all other agreements, whether written or oral, between the parties regarding the subject matter contained herein.
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Related to Compensation to Participating Providers

  • Participating Providers To find out if a Provider is a Participating Provider: • Check Our Provider directory, available at Your request; • Call the number on Your ID card; or • Visit our website at ▇▇▇.▇▇▇▇▇▇.▇▇▇. The Provider directory will give You the following information about Our Participating Providers: • Name, address, and telephone number; • Specialty; • Board certification (if applicable); • Languages spoken; and • Whether the Participating Provider is accepting new patients.

  • Services and Compensation Consultant shall perform the services described in Exhibit A (the “Services”) for the Company (or its designee), and the Company agrees to pay Consultant the compensation described in Exhibit A for Consultant’s performance of the Services.

  • Compensation to NCPS (a) Issuer Party shall pay or cause to be paid to NCPS for its services as the facilitator of escrow as outlined in Exhibit B, which may be updated from time to time by NCPS by providing written notice to Issuer Party. Issuer Party’s obligation to pay such fees to NCPS and reimburse NCPS for such expenses is not conditioned upon a successful closing. Upon Issuer Party’s request, NCPS will provide Issuer Party with copies of all relevant invoices, receipts or other evidence of such expenses. The obligations of Issuer Party under this Section 10 shall survive any termination of this Agreement and the resignation or removal of NCPS. (b) All of the compensation and reimbursement obligations shall be payable by Issuer Party upon demand by NCPS and will be charged automatically by NCPS to the credit card or other payment method separately provided or as otherwise agreed by the Parties. Issuer Party consents to NCPS retaining and using Issuer Party’s payment information for future invoices and as provided in this Agreement. Issuer Party agrees and acknowledges that NCPS and its third party vendors may retain and use Issuer Party’s payment information to facilitate the payments provided for in this Agreement. Issuer Party agrees to provide NCPS written notice (which may be via email) of any update or changes to Issuer Party’s payment information. Absent current payment information, Issuer Party shall make, or cause to be made, all payments to NCPS within 10 days of receiving an invoice therefor. All payments made to NCPS shall be in US dollars in immediately available funds. (c) If Issuer Party fails to make any payment when due then, in addition to all other remedies that may be available: (a) NCPS may charge interest on the past due amount at the rate of 1.5% per month, calculated daily and compounded monthly, or if lower, the highest rate permitted under Law, which Issuer Party shall pay; such interest may accrue after as well as before any judgment relating to collection of the amount due; and (b) Issuer Party shall reimburse, or cause to be reimbursed, NCPS for all costs incurred by NCPS in collecting any late payments or interest, including attorneys’ fees, court costs and collection agency fees; provided that cumulative late payments are subject to the overall limits as may be required by Law as set forth in Exhibit B. (d) Only upon the fulfillment of the Minimum Offering, and only when Escrowed Funds are eligible to be released to Issuer in accordance with Section 4(a), and otherwise in compliance with Law, NCPS is authorized to and may disburse from time to time, to itself or to any NCPS Party from the Escrow Funds (but only to the extent of Issuer’s rights thereto), the amount of any compensation and reimbursement of out-of-pocket expenses due and payable hereunder (including any amount to which NCPS or any NCPS Party is entitled to seek indemnification pursuant to Section 9 hereof). NCPS shall notify Issuer Party of any disbursement from the Escrow Funds to itself or to any NCPS Party in respect of any compensation or reimbursement hereunder and shall furnish to Issuer copies of all related invoices and other statements. (e) Only upon the fulfillment of the Minimum Offering, and only when Escrowed Funds are eligible to be released to Issuer in accordance with Section 4(a), and otherwise in compliance with Law, Issuer shall grant to NCPS and the NCPS Parties a security interest in and lien upon such Escrow Funds (but only to the extent of Issuer’s rights thereto) to secure all obligations hereunder, and NCPS and the NCPS Parties shall have the right to offset the amount of any compensation or reimbursement due any of them hereunder (including any claim for indemnification pursuant to Section 9 hereof) against the Escrow Funds (but only to the extent of Issuer’s rights thereto). If for any reason the Escrow Funds available to NCPS and the NCPS Parties pursuant to such security interest or right of offset are insufficient to cover such compensation and reimbursement, Issuer Party shall promptly pay such amounts to NCPS and the NCPS Parties upon receipt of an itemized invoice.

  • Fees and Compensation Managers and Officers may receive such compensation and fees, if any, for their services, and such reimbursement for expenses, as may be determined by resolution of the Board.

  • COMPENSATION TO CONSULTANT The Consultant's compensation for the Consulting Services shall be as set forth in Exhibit B attached hereto and incorporated herein by this reference.