Common use of Third Party Billing Clause in Contracts

Third Party Billing. The Subcontractor shall adhere to the following guidelines when billing Managing Entity: a. Services are not reimbursable for the following: 1. Individuals who have third party insurance coverage when the services provided are paid under the insurance plan; or 2. Medicaid enrollees or recipients of another publicly funded health benefits assistance program, when the services provided are paid by said program. b. Services are reimbursable for the following: 1. Individuals who have lost coverage through Medicaid, or any other publicly funded health benefits assistance program coverage for any reason during the period of non-coverage; or 2. Individuals who have a net family income less than 150 percent of the Federal Poverty Income Guidelines, subject to the sliding fee scale requirements in Rule 65E-14.018 F.A.C.