Network Provider. An appropriately credentialed and licensed individual, facility, agency, institution, organization, or other entity that has an agreement with the Contractor or any subcontractor, for the delivery of services covered under the Contract.
Network Provider. Any provider, group of providers, or entity that is credentialed and has a valid network provider agreement with the Contractor, or a Subcontractor, and receives Medicaid funding directly or indirectly to order, refer or render covered services as a result of the state’s contract with the Contractor. A network provider is not a Subcontractor by virtue of the network provider agreement.
Network Provider. In accordance with 42 C.F.R. §438.2, any provider, group of providers, or entity that has a network provider agreement with a MCO, PIHP, or PAHP, or a subcontractor, and receives Medicaid funding directly or indirectly to order, refer or render covered services as a result of the state's contract with an MCO, PIHP, or PAHP. A network provider is not a subcontractor by virtue of the network provider agreement.
Network Provider an Ancillary Provider, Professional Provider, or Facility Provider who has an agreement, either directly or indirectly, with the Plan pertaining to payment as a Network participant for Covered Services rendered to a Member.
Network Provider. An appropriately credentialed and licensed individual, facility, agency, institution, organization, or other entity that has an agreement with the Contractor or any subcontractor, for the delivery of services covered under the Contract. Ombudsman — A neutral entity that has been contracted by MassHealth to assist Enrollees (including their families, caregivers, representatives, and/or advocates) with information, issues, or concerns related to One Care (may also be referred to as My Ombudsman). Ombudsman staff fulfill both individual and systemic advocacy roles. One Care Plan — A health plan or provider‑based organization located in the United States contracted to provide and accountable for providing or arranging for the provision of integrated care to Enrollees under a capitated payment arrangement. Previously referenced as Integrated Care Organization (ICO).
Network Provider. An appropriately credentialed and licensed individual, facility, agency, institution, organization, or other entity that has an agreement with the Contractor, or any subcontractor, for the delivery of services covered under the Contract. Ombudsperson — A neutral and conflict-free person or entity that provides assistance to plan members with access, billing and service issues. The Ombudsperson provides information on the plan Grievance and Appeal guidelines and can guide the Enrollee through that process. He or she can also perform mediation between the Enrollee and the ICO. One Care Plan — A health plan or provider-based organization contracted to provide and accountable for providing integrated care to Enrollees. All Contractors participating in the Demonstration shall be designated as One Care plans (also known as ICOs). See also Integrated Care Organization (ICO).
Network Provider an entity that receives Federal and/or State funds from a Region through a subaward, contract or other agreement and is responsible for ensuring compliance with all state and Federal statutes, regulations, rules, conditions and limitations associated with these funds.
Network Provider. The network provider for primary access also determines the applicable service levels. All SLAs provided herein are for the Verizon Network except where noted. The networks covered under the Managed WAN SLA are divided into three categories:
1. Verizon Network – PIP, FR, ATM or PL provided by MCI Legacy Companies, PIP Layer 2 Service, Ethernet Private Line (EPL), Ethernet E-LAN and E-Line, Ethernet Virtual Private Line Service (EVPL) CPA-Based, Virtual Private LAN Service (VPLS), and Verizon-approved Internet Dedicated Access and Internet Dedicated Ethernet transport services.
2. Other Verizon Networks – Verizon IP VPN as referenced in Verizon Tariff F.C.C. No. 20, Verizon Local Private Line as referenced in Verizon Tariff F.C.C. No. 1 and F.C.C No. 11, Verizon Fast Packet – ATM as referenced in Verizon Tariff F.C.C. No. 1 and F.C.C. No. 20, Verizon Fast Packet – Frame Relay as referenced in Verizon Tariff F.C.C. No. 20 Verizon Wireless EVDO and LTE access.
Network Provider. Any provider, group of providers, or entity that is credentialed by the CVO and has a valid network provider agreement with the Contractor, or a Subcontractor, and receives Medicaid funding directly or indirectly to order, refer or render covered services as a result of the state’s contract with the Contractor. A network provider is not a Subcontractor by virtue of the network provider agreement.
Network Provider. A Network Provider is a licensed mental health professional whose scope of practice permits the provision of specialty mental health services and psychotherapy directly to CLIENTS without supervision. This provider type includes Individual and Group Providers. A Group Provider is an independent practice association, or hospital outpatient department. CONTRACTOR may provide these services in an inpatient or outpatient setting. However, all services must have prior authorization
