Common use of Program Payments Clause in Contracts

Program Payments. On behalf of Customer, Administrator will pay Pharmacy, or in the event Pharmacy directs Administrator to pay Pharmacy’s agent, then Administrator will pay Pharmacy’s agent, the amount indicated by the transaction response for transactions properly submitted to Administrator in accordance with this Agreement, including the applicable program-specific Exhibit (“Amount Due Pharmacy”). If Pharmacy or Pharmacy’s agent collects from the Eligible Patient more than the amount indicated on a Program transaction response, such action will constitute a material breach of this Agreement. A transaction response indicating a claim is payable is not a guarantee of payment. Administrator reserves the right to review all claims submitted by Pharmacy, at any time, for compliance with this Agreement and Program requirements. Administrator may deny claims for noncompliance, delay payment for further review of claims, or withhold payment for non-compliant claims prior to remitting payment to Pharmacy or Pharmacy’s agent. If Administrator has paid to Pharmacy or Pharmacy’s agent claims it subsequently determines were non-compliant, Administrator may retroactively deny such claims and recoup amounts paid from Pharmacy or Pharmacy’s agent or offset amounts paid from future Amounts Due Pharmacy, if any. In the event the Administrator is unable to recoup amounts owed by Pharmacy under this section from Pharmacy’s agent, Administrator may recover those amounts directly from Pharmacy. In the event Administrator delays or withholds payment or denies a claim pursuant to this Agreement, Pharmacy or Pharmacy’s agent may not balance bill the patient or seek to recover any additional payment from the patient for the related claim. If Administrator or Pharmacy terminates Pharmacy’s participation or Administrator determines, in its sole discretion, future Amounts Due Pharmacy, if any, would be less than amounts Administrator intends to recoup, Administrator may send Pharmacy or Pharmacy’s agent written demand for payment, which Pharmacy or Pharmacy’s agent will pay in full within fifteen (15) calendar days. Administrator may offset any amounts owed to Administrator by Pharmacy or Pharmacy’s agent against any amounts due to Pharmacy by any Administrator affiliate. Under no circumstances will Pharmacy or Pharmacy’s agent be entitled to receive any payments other than the Amount Due Pharmacy for the Program under which a Pharmacy is processing the transaction on behalf of the Eligible Patient.

Program Payments. On behalf of Customer, Administrator will pay Pharmacy, or in the event Pharmacy directs Administrator to pay Pharmacy’s agent, then Administrator will pay Pharmacy’s agent, the amount indicated by the transaction response for transactions properly submitted to Administrator in accordance with this Agreement, including the applicable program-specific Exhibit (“Amount Due Pharmacy”). If Pharmacy or Pharmacy’s agent collects from the Eligible Patient more than the amount indicated on a Program transaction response, such action will constitute a material breach of this Agreement. A transaction response indicating a claim is payable is not a guarantee of payment. Administrator reserves the right to review all claims submitted by Pharmacy, at any time, for compliance with this Agreement and Program requirements. Administrator may deny claims for noncompliance, delay payment for further review of claims, or withhold payment for non-compliant claims prior to remitting payment to Pharmacy or Pharmacy’s agent. If Administrator has paid to Pharmacy or Pharmacy’s agent claims it subsequently determines were non-compliant, Administrator may retroactively deny such claims and recoup amounts paid from Pharmacy or Pharmacy’s agent or offset amounts paid from future Amounts Due Pharmacy, if any. In the event the Administrator is unable to recoup amounts owed by Pharmacy under this section from Pharmacy’s agent, Administrator may recover those amounts directly from Pharmacy. In the event Administrator delays or withholds payment or denies a claim pursuant to this Agreement, Pharmacy or Pharmacy’s agent may not balance bill the patient or seek to recover any additional payment from the patient for the related claim. If Administrator or Pharmacy terminates Pharmacy’s participation or Administrator determines, in its sole discretion, future Amounts Due Pharmacy, if any, would be less than amounts Administrator intends to recoup, Administrator may send Pharmacy or Pharmacy’s agent written demand for payment, which Pharmacy or Pharmacy’s agent will pay in full within fifteen (15) calendar days. Administrator may offset any amounts owed to Administrator by Pharmacy or Pharmacy’s agent against any amounts due to Pharmacy by any Administrator affiliate. Under no circumstances will Pharmacy or Pharmacy’s agent be entitled to receive any payments other than the Amount Due Pharmacy for the Program under which a Pharmacy is processing the transaction on behalf of the Eligible Patient.