Verify Member Eligibility Sample Clauses

The 'Verify Member Eligibility' clause establishes the requirement for confirming that individuals meet specific criteria before being granted membership or access to certain benefits. In practice, this clause typically mandates a review of documentation, status, or qualifications—such as age, employment, or residency—prior to approval. Its core function is to ensure that only eligible individuals participate, thereby maintaining the integrity of the membership process and preventing unauthorized access or misuse.
Verify Member Eligibility. Prior to furnishing any Covered Prescription Service, PHARMACY shall verify that the individual receiving such Covered Prescription Service is an eligible Member. Such verification shall be performed by the PHARMACY through point-of-service (“POS”) data communication between the PHARMACY and Claims Processor. If any PHARMACY is unable to confirm a Member’s eligibility by POS communication, then the PHARMACY shall call SOUTHERN SCRIPTS’ pharmacy help desk (or equivalent) for verification.
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Verify Member Eligibility. Determine the Medical Necessity of medical transportation services in accordance with the Medical Necessity standards set forth in the applicable Administrative Manual. Any claim that would be denied on the basis of Medical Necessity shall be referred to the Contracted Health Plan prior to denial. Except as otherwise provided in the applicable Administrative Manual, (a) the Contracted Health Plan, or its designee, shall be sorely responsible for notifying the Member of the denial of any claim; and (b) CONTRACTOR shall not contact the Member with respect to any denial of claims. If the Contracted Health Plan approves the claim, it shall notify CONTRACTOR of the approval, and CONTRACTOR shall promptly pay the claim. Notwithstanding the foregoing, if Customer's referral authorization is included in the claims submission, then the Medical Necessity of the claims will be deemed to be determined, and further review will not be required.
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Related to Verify Member Eligibility

  • Member Eligibility Verify Member eligibility contemporaneous with the rendering of services. BCBS will provide systems and/or methods for verification of eligibility and benefit coverage for Members. This is furnished as a service and not as a guarantee of payment;

  • Membership Eligibility To join the Credit Union, you must meet the membership requirements, including purchase and maintenance of the minimum required share(s) (“membership share”) as set forth in the Credit Union’s bylaws. You authorize us to check your account, credit and employment history, and obtain reports from third parties, including credit reporting agencies, to verify your eligibility for the accounts and services you request.

  • Benefit Eligibility For purposes of the Benefit Plan entitlement, common-law and same sex relationships will apply as defined.

  • Program Eligibility The COUNTY shall provide eligibility determination for those persons applying for home repair under this Agreement by using the following factors: 1. The applicant is a resident of the CITY; and 2. The total income for all members of the applicant’s household does not exceed 80% of the median income of the Kansas City metropolitan area, as determined by the Secretary of Housing and Urban Development; and 3. The applicant is the homeowner and must have occupied the property as a primary residence for at least six (6) months; 4. The property to be repaired is within the corporate limits of the CITY; and 5. When required, medical need will be substantiated and documented.

  • Contribution Eligibility You are eligible to make a regular contribution to your ▇▇▇▇ ▇▇▇, regardless of your age, if you have compensation and your MAGI is below the maximum threshold. Your ▇▇▇▇ ▇▇▇ contribution is not limited by your participation in an employer-sponsored retirement plan, other than a Traditional IRA.