Common use of Third Party Reimbursement Clause in Contracts

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. a. CONTRACTOR shall first ▇▇▇▇ bill other third-party payers for Inpatient, Outpatient and Physician Services, including but not limited to, private insurance, Medicare, Medi-Cal, TB Medi-Cal, and 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 shall not be responsible for reimbursement of reimburse 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 is or 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 ninety (18090) calendar days, unless the delay is related to the third third-party payer appeal process. COUNTY shall have has 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 third-party payer appeal process. If claims are submitted more than one hundred eighty ninety (18090) 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 has no liability for payment of claims or invoices delayed due to a third third-party payer appeal process, process if claims or invoices submitted are more than two one hundred seventy four eighty (274180) calendar days after the dates of service provided.