Third Party Reimbursement Sample Clauses

Third Party Reimbursement. Except as set forth on Schedule 4.22 of the Disclosure Schedule, complete copies of all third party reimbursement agreements relating to the operation of the Business of the Group Companies (the “Reimbursement Agreements”) that are currently in force have been delivered to Buyer prior to the execution of this Agreement. There are no facts or circumstances that could result in (a) the cancellation or non-renewal of any Reimbursement Agreement (except to the extent provided in a termination “without cause” provision); or (b) any retroactive adjustment by any payor under any Reimbursement Agreement.

Third Party Reimbursement. If any Credit Party is or has been audited by Medicare, Medicaid, TRICARE, CHAMPVA or similar governmental payors, none of such audits provides for adjustments in reimbursable costs or asserts claims for reimbursement or repayment by such Credit Party of costs and/or payments theretofore made by such governmental payor that, if adversely determined, could reasonably be expected to have or result in a Material Adverse Effect.

Third Party Reimbursement a. Contractor will comply with N.C.G.S. §122C-146, which requires the LME/PIHP to make every reasonable effort to collect payments from third party payors. Each time an Enrollee receives services Contractor shall determine if the Enrollee has third party coverage that covers the service provided. b. Contractor is required to ▇▇▇▇ all applicable third party payors prior to billing the LME/PIHP. 1) Medicaid benefits payable through the LME/PIHP are secondary to benefits payable by a primary payer, including Medicare, even if the primary payer states that its benefits are secondary to Medicaid benefits or otherwise limits its payments to Medicaid enrollees. 2) The LME/PIHP makes secondary payments to supplement the primary payment if the primary payment is less than the lesser of the usual and customary charges for the service or the rate established by the LME/PIHP. 3) The LME/PIHP does not make a secondary payment if the Contractor is either obligated to accept, or voluntarily accepts, as full payment, a primary payment that is less than its charges. 4) If Contractor or Enrollee receives a reduced primary payment because of failure to file a proper claim with the primary payor, the LME/PIHP secondary payment may not exceed the amount that would have been payable if the primary payer had paid on the basis of a proper claim. 5) Contractor must inform the LME/PIHP that a reduced payment was made, and the amount that would have been paid if a proper claim had been filed. c. Contractor shall ▇▇▇▇ the LME/PIHP for third party co-pays and/or deductibles only as permitted by Controlling Authority.

Third Party Reimbursement. In addition to the cancellation fees due under Clauses 4.2 and 4.4, the Client will reimburse the Hotel (on an indemnity basis) for any expenditure incurred in respect of any cancelled Event including (but not limited to) any costs, charges or penalties as a result of having to make consequential cancellation of its own arrangements with third parties in relation to the Event.

Third Party Reimbursement. (a) The Corporation and each of the other Members of the Obligated Group is duly authorized and licensed and certified to operate its Facilities (as hereinafter defined) and receive reimbursement therefor (to the extent reimbursement is applicable and available) under applicable Missouri law. As used herein, “Facilities” means any and all right, title and interest in and to property, plant and equipment of the Corporation, each other Member or such Affiliate.

Third Party Reimbursement a. CONTRACTOR shall first ▇▇▇▇ other third-party payers for Inpatient, Outpatient and Physician Services, including but not limited to, private insurance, Medicare, Medi-Cal, TB Medi-Cal, CalOptima, and the MSI Program for services provided to eligible Public Health Patients. When billing COUNTY for patients for whom revenue has not been received, CONTRACTOR shall submit to COUNTY a copy of the written denial of payment. b. CONTRACTOR shall be responsible to appeal all denials of services related to third-party payers in a timely fashion prior to submitting invoices to COUNTY for payment. c. COUNTY will not be responsible for reimbursement of services where CONTRACTOR has not billed or appealed the claim to a third-party payer according to industry standards. d. Any reimbursement of services by COUNTY for Public Health Patients shall be limited to reimbursement of services for which no payment will be made through a third-party payer. COUNTY shall not reimburse any deductibles or co-payments required by a Public Health Patient’s insurance coverage. e. CONTRACTOR shall submit Inpatient, Outpatient and Physician Services claims with dates of service no older than those provided in the past one hundred eighty (180) calendar days, unless the delay is related to the third party payer appeal process. COUNTY shall have no liability for payment of claims or invoices submitted more than one hundred eighty (180) calendar days after the dates of service provided, unless the delay is related to the third party payer appeal process. If claims are submitted more than one hundred eighty (180) calendar days after the dates of services provided, CONTRACTOR shall include supporting documentation of a third party payer appeal process for said claims. COUNTY shall have no liability for payment of claims or invoices delayed due to a third party payer appeal process, if claims or invoices submitted are more than two hundred seventy four (274) calendar days after the dates of service provided.

Third Party Reimbursement. If any Credit Party is or has been audited by Medicare, Medicaid, CHAMPUS, CHAMPVA or similar governmental Third Party Payors, (i) none of such audits provides for adjustments in reimbursable costs or asserts claims for reimbursement or repayment by such Credit Party of costs and/or payments theretofore made by such governmental Third Party Payor that, if adversely determined, could reasonably be expected to have or result in a Material Adverse Effect and (ii) none of the Credit Parties have had requests or assertions of claims for reimbursement or repayment by it of costs and/or payments heretofore made by any other Third Party Payor that, if adversely determined, could reasonably be expected to have or result in a Material Adverse Effect, except in either case to the extent described on SCHEDULE 4.21.

Third Party Reimbursement. If the Borrower or any other Loan Party is or has been audited by Medicare, Medicaid or similar governmental Third Party Payors, to the knowledge of the Loan Parties, (a) none of such audits provides for adjustments in reimbursable costs or asserts claims for reimbursement or repayment by such Person of costs and/or payments theretofore made by such governmental Third Party Payor that, if adversely determined, individually or in the aggregate, could reasonably be expected to result in material claims against such Person and (b) none of such Persons has had requests or assertions of claims for reimbursement or repayment by it of costs and/or payments heretofore made by any other Third Party Payor that, if adversely determined, individually or in the aggregate, could reasonably be expected to result in material claims against such Person.

Third Party Reimbursement. If the Service Provider or any Service Provider Employee is being audited or has been audited by Medicare, Medicaid, CHAMPUS or CHAMPVA or similar governmental Third Party Payors: (a) none of such audits provides for adjustments in reimbursable costs or assets, claims for reimbursement or repayment by the Service Provider or any Service Provider Employee of costs and/or payments theretofore made by such governmental Third Party Payor that, if adversely determined, could reasonably be expected to have or result in a Material Adverse Effect; and (b) neither the Service Provider nor any Service Provider Employee has had requests or assertions of claims for reimbursement or repayment by it, or him or her, as the case may be, of costs and/or payments heretofore made by any other Third Party Payor that, if adversely determined, could reasonably be expected to have or result in a Material Adverse Effect.