Preauthorization and claims Sample Clauses

Preauthorization and claims. (i) The Provider agrees to follow and adhere to the online pre-authorization and claims workflow of the Scheme in providing services to its Beneficiaries. (ii) The Provider shall submit the pre-authorization request on the web portal, after admitting the patient as inpatient. The documents will include signed copy of consent, digital photograph, all relevant test reports, X ray, CT Scan, MRI films, biopsy/cytology reports along with those taken in the hospital should be scanned/ digitized and uploaded, with the proposed treatment along with doctor notes etc. The ISA shall approve the preauthorization within 6 hours of submission of documents by the Hospital any queries by ISA shall be answered without delay. (iii) The pre-authorization is applicable only for a period of 14 (fourteen) days, including the date of issue. The pre-authorization is only provided to a specific provider and is not transferable. However may be extended for additional 7 (seven) days, if a written request is made by the provider/ hospital. Beyond 21 (twenty one) days, the pre-authorization will stand cancelled. In such cases the provider should obtain fresh approval for the cancelled pre-authorizations by mentioning valid reasons. (iv) In case of extended stay, additional procedure or any readmission arising out of complication authorization is required, a fresh query will be raised by the Provider. (v) In cases of emergency, the Provider will obtain emergency telephonic approval. The ISA in coordination with State Health Agency reserves the right to cancel the emergency telephonic approval, if the Provider fails to update the details of the Beneficiary, online within 6 (six) hours of emergency telephonic approval. The Provider also agrees to update the Surgery / Therapy details online for telephonic approvals, mentioning the date and time along with specific remarks and photographic evidences, starting from the telephonic intimation. (vi) The Provider, will update the Surgery/ procedure details on the portal, online after performing the surgery including surgical notes and other clinical documents, within 7 (seven) days of the date of the surgery or prior to the last day of validity of the pre-authorization, whichever is earlier. This information is required to confirm, if the surgery/ procedure has been undertaken, as per the available approvals. (vii) The Provider, after 10 (ten) days of discharge of the Beneficiary, will uploads the original ▇▇▇▇, discharge summary and other rele...
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Related to Preauthorization and claims

  • Required Preauthorization Prescription drugs for which preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. For details on how to obtain prescription drug preauthorization for a prescription drug, see Prescription Drug Preauthorization in Section 3 for details. If preauthorization is not obtained, you will be required to pay for the prescription drug at the pharmacy. You can ask us to consider reimbursement after you receive the prescription drug by following the prescription drug preauthorization process. For a list of prescription drugs that require preauthorization, visit our website or call our Customer Service Department.

  • Investigation and Prevention DST shall reasonably assist Fund in investigating of any such unauthorized access and shall use commercially reasonable efforts to: (A) cooperate with Fund in its efforts to comply with statutory notice or other legal obligations applicable to Fund or its clients arising out of unauthorized access and to seek injunctive or other equitable relief; (B) cooperate with Fund in litigation and investigations against third parties reasonably necessary to protect its proprietary rights; and (C) take reasonable actions necessary to mitigate loss from any such authorized access.

  • Workplace Violence Prevention and Crisis Response (applicable to any Party and any subcontractors and sub-grantees whose employees or other service providers deliver social or mental health services directly to individual recipients of such services): Party shall establish a written workplace violence prevention and crisis response policy meeting the requirements of Act 109 (2016), 33 VSA §8201(b), for the benefit of employees delivering direct social or mental health services. Party shall, in preparing its policy, consult with the guidelines promulgated by the U.S. Occupational Safety and Health Administration for Preventing Workplace Violence for Healthcare and Social Services Workers, as those guidelines may from time to time be amended. Party, through its violence protection and crisis response committee, shall evaluate the efficacy of its policy, and update the policy as appropriate, at least annually. The policy and any written evaluations thereof shall be provided to employees delivering direct social or mental health services. Party will ensure that any subcontractor and sub-grantee who hires employees (or contracts with service providers) who deliver social or mental health services directly to individual recipients of such services, complies with all requirements of this Section.

  • Litigation and Environmental Matters (a) There are no actions, suits or proceedings by or before any arbitrator or Governmental Authority pending against or, to the knowledge of the Borrower, threatened against or affecting the Borrower or any of its Subsidiaries (i) as to which there is a reasonable possibility of an adverse determination and that, if adversely determined, could reasonably be expected, individually or in the aggregate, to result in a Material Adverse Effect (other than the Disclosed Matters) or (ii) that involve this Agreement or the Transactions. (b) Except for the Disclosed Matters and except with respect to any other matters that, individually or in the aggregate, could not reasonably be expected to result in a Material Adverse Effect, neither the Borrower nor any of its Subsidiaries (i) has failed to comply with any Environmental Law or to obtain, maintain or comply with any permit, license or other approval required under any Environmental Law, (ii) has become subject to any Environmental Liability, (iii) has received notice of any claim with respect to any Environmental Liability or (iv) knows of any basis for any Environmental Liability. (c) Since the date of this Agreement, there has been no change in the status of the Disclosed Matters that, individually or in the aggregate, has resulted in, or materially increased the likelihood of, a Material Adverse Effect.

  • Preauthorized EFTs If you have arranged to have a direct deposit or preauthorized debit or credit made to your account at least once every 60 days from the same person or company, you can call us at (▇▇▇) ▇▇▇-▇▇▇▇ or use telephone access or Home Banking to find out whether or not the deposit has been made.