Provider Refunds of Claims Reimbursed By Other Payments Clause Samples

Provider Refunds of Claims Reimbursed By Other Payments. 6 1. Refunds received from Contracting Hospitals shall be as specified in the MSI Hospital 7 Agreement and for the purposes of this Paragraph shall not be included in the definition of “Provider” as 8 follows, which shall mean All Providers except Contracting Hospitals. 9 2. If any Provider through its own efforts, identifies Medi-Cal coverage, third party 10 settlement, primary or other insurance coverage for services reimbursed through the Agreement, such 11 Provider(s) shall, within thirty (30) calendar days of such identification, unless disputed in accordance 12 with subparagraph G.5. below, reimburse INTERMEDIARY an amount equal to the MSI Payment. At 13 ADMINISTRATOR’s sole discretion, Skilled Nursing Facility providers may reimburse 14 INTERMEDIARY an amount equal to the Medi-Cal coverage, third party settlement, primary or other 15 insurance coverage for services or MSI reimbursement amount, whichever is less. 16 3. If Medi-Cal coverage, third party settlement, primary or other insurance coverage is 18 subparagraph G.7. below, the Provider shall, within thirty (30) days of notice from Recovery Services, 19 unless disputed in accordance with subparagraph G.5. below, reimburse COUNTY through 20 INTERMEDIARY an amount equal to the MSI payment. Third-party settlement payments may be paid 21 directly to COUNTY or INTERMEDIARY, as directed by ADMINISTRATOR if the date(s) of service 22 related to the claim are such that the Provider has already written off the patient account. 23 4. If it is determined that a patient whose care was previously reimbursed with MSI funding 24 was eligible for third party reimbursement or primary other insurance, retroactively or otherwise, and 25 Provider could have sought such reimbursement and failed to do so, Provider shall reimburse COUNTY
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Provider Refunds of Claims Reimbursed By Other Payments. 28 1. Refunds received from Contracting Hospitals shall be as specified in the MSI Hospital 29 Agreement and for the purposes of this Paragraph shall not be included in the definition of “Provider” as 30 follows, which shall mean All Providers except Contracting Hospitals. 31 2. If any Provider through its own efforts, identifies Medi-Cal coverage, third party 32 settlement, primary or other insurance coverage for services reimbursed through the Agreement, such 33 Provider(s) shall, within thirty (30) calendar days of such identification, unless disputed in accordance 34 with subparagraph G.54. below, reimburse INTERMEDIARYCONTRACTOR an amount equal to the 35 MSIMSN Payment. At ADMINISTRATOR’s sole discretion, Skilled Nursing Facility providers may 36 reimburse INTERMEDIARYCONTRACTOR an amount equal to the Medi-Cal coverage, third party 37 settlement, primary or other insurance coverage for services or MSIMSN reimbursement amount, 1 whichever is less.
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Provider Refunds of Claims Reimbursed By Other Payments. Refunds received from Contracting Hospitals shall be as specified in the MSI Hospital 23 Agreement and for the purposes of this Paragraph shall not be included in the definition of “Provider”.
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Related to Provider Refunds of Claims Reimbursed By Other Payments

  • Claims Payment The Reinsurer will be liable to the Company for its share of the benefits owed under the express contractual terms of the Reinsured Policies and as specified under the terms of this Agreement. The Reinsurer will not participate in any ex gratia payments made by the Company (i.e., payments the Company is not required to make under the Reinsured Policy terms.) The payment of death benefits by the Reinsurer will be in one lump sum regardless of the mode of settlement under the Reinsured Policy. Benefit payments from the Reinsurer will be due within 30 days of the claim satisfying the requirements established under this Agreement. The Reinsurer’s share of any interest payable under the terms of a Reinsured Policy or applicable law which is based on the death benefits paid by the Company, will be payable provided that the Reinsurer will not be liable for interest accruing on or after the date of the Company’s payment of benefits. The Reinsurer’s share will be based upon the same interest rate and days used by the Company to calculate their interest paid. The Reinsurer will make payment to the Company for each such claim. For Waiver of Premium claims, the Company will continue to pay premiums for reinsurance, except premiums for disability reinsurance. The Reinsurer will pay its proportionate share of the gross premium waived by the Company on the Reinsured Policy, including its share of the premiums for benefits that remain in effect during disability. I414849US-12 (11-01-2011) QT#04028US11 (COLI & B▇▇▇) For claims on Accelerated Benefit riders reinsured under this Agreement, the benefit amount payable by the Reinsurer will be calculated by multiplying the total accelerated death benefit rider payout by the ratio of the reinsured Net Amount at Risk, as defined in Exhibit C -1, to the face amount of the Reinsured Policy.

  • Maintenance of PMI Policy; Claims With respect to each Mortgage Loan with a loan-to-value ratio in excess of 80% for which a PMI Policy is both required and has been issued, the Servicer shall, to the extent permitted by Accepted Servicing Practices, maintain or cause the Mortgagor to maintain in full force and effect a PMI Policy insuring that portion of the Mortgage Loan in excess of 75% of value, and shall cause the Mortgagor to pay the premium thereon on a timely basis, until the loan-to-value ratio of such Mortgage Loan is reduced to 80% or PMI can otherwise no longer be mandated pursuant to applicable law. In the event that such PMI Policy shall be terminated, the Servicer shall attempt to obtain from another Qualified Insurer a comparable replacement policy, with a total coverage equal to the remaining coverage of such terminated PMI Policy. The Servicer shall not take any action which would result in noncoverage under any applicable PMI Policy of any loss which, but for the actions of the Servicer would have been covered thereunder. In connection with any assumption or substitution agreement entered into or to be entered into pursuant to this Agreement, the Servicer shall promptly notify the insurer under the related PMI Policy, if any, of such assumption or substitution of liability in accordance with the terms of such PMI Policy and shall take all actions which may be required by such insurer as a condition to the continuation of coverage under such PMI Policy. If such PMI Policy is terminated as a result of such assumption or substitution of liability, the Servicer shall obtain a replacement PMI Policy as provided above. With respect to each Mortgage Loan covered by a PMI Policy or LPMI Policy, the Servicer shall take all such actions on behalf of the Owner as are necessary to service, maintain and administer the related Mortgage Loan in accordance with such Policy and to enforce the rights under such Policy. Except as expressly set forth herein, the Servicer shall have full authority on behalf of the Owner to do anything it deems appropriate or desirable in connection with the servicing, maintenance and administration of such Policy; provided that the Servicer shall not take any action to permit any modification or assumption of a Mortgage Loan covered by a LPMI or PMI Policy, or take any other action with respect to such Mortgage Loan, which would result in non-coverage under such Policy of any loss which, but for actions of the Servicer, would have been covered thereunder. The Servicer shall cooperate with the PMI insurers and shall furnish all reasonable evidence and information in the possession of the Servicer to which the Servicer has access with respect to the related Mortgage Loan. The Servicer agrees to prepare and present, on behalf of itself and the Owner, claims to the insurer under any PMI Policy or LPMI Policy in a timely fashion in accordance with the terms of such PMI Policy or LPMI Policy and, in this regard, to take such action as shall be necessary to permit recovery under any PMI Policy or LPMI Policy respecting a defaulted Mortgage Loan. Pursuant to Section 3.04, any amounts collected by the Servicer under any PMI Policy or LPMI Policy shall be deposited in the Collection Account, subject to withdrawal pursuant to Section 3.05.

  • Additional Escrow Amounts On the date of any Purchase Withdrawal, the Pass Through Trustee may re-deposit with the Depositary some or all of the amounts so withdrawn in accordance with Section 2.4 of the Deposit Agreement.

  • Payment of Claims A. If advance payment of all or a portion of the Grant funds is permitted by statute or regulation, and the State agrees to provide such advance payment, advance payment shall be made only upon submission of a proper claim setting out the intended purposes of those funds. After such funds have been expended, Grantee shall provide State with a reconciliation of those expenditures. Otherwise, all payments shall be made thirty five (35) days in arrears in conformance with State fiscal policies and procedures. As required by IC § 4-13-2-14.8, all payments will be by the direct deposit by electronic funds transfer to the financial institution designated by the Grantee in writing unless a specific waiver has been obtained from the Indiana Auditor of State B. Requests for payment will be processed only upon presentation of a Claim Voucher in the form designated by the State. Such Claim Vouchers must be submitted with the budget expenditure report detailing disbursements of state, local and/or private funds by project budget line items. C. The State may require evidence furnished by the Grantee that substantial progress has been made toward completion of the Project prior to making the first payment under this Grant. All payments are subject to the State's determination that the Grantee's performance to date conforms with the Project as approved, notwithstanding any other provision of this Grant Agreement. D. Claims shall be submitted to the State within 10 calendar days following the end of the month in which work on or for the Project was performed. The State has the discretion, and reserves the right, to NOT pay any claims submitted later than 35 calendar days following the end of the month in which the services were provided. All final claims and reports must be submitted to the State within 10 calendar days after the expiration or termination of this agreement. Payment for claims submitted after that time may, at the discretion of the State, be denied. Claims may be submitted on a monthly basis only. If Grant funds have been advanced and are unexpended at the time that the final claim is submitted, all such unexpended Grant funds must be returned to the State. E. Claims must be submitted with accompanying supportive documentation as designated by the State. Claims submitted without supportive documentation will be returned to the Grantee and not processed for payment. Failure to comply with the provisions of this Grant Agreement may result in the denial of a claim for payment.

  • Tax Claims Notwithstanding any other provision of this Agreement, the control of any claim, assertion, event or proceeding in respect of Taxes of the Company (including, but not limited to, any such claim in respect of a breach of the representations and warranties in Section 3.22 hereof or any breach or violation of or failure to fully perform any covenant, agreement, undertaking or obligation in Article VI) shall be governed exclusively by Article VI hereof.