Participating Provider. A provider who has contracted with the health plan to deliver medical/behavioral health services to covered persons. The provider may be a physician, hospital, pharmacy, other facility or other healthcare provider who has contractually accepted the terms and conditions set forth by the health plan. Also known as network or in-network provider.
Participating Provider. A Provider that has a Provider Agreement with United Concordia Dental pertaining to payment for Covered Services rendered to a Member.
Participating Provider. A Provider who meets InterWest’s provider credentialing standards and participation requirements and agrees under contract with InterWest to provide Covered Services to Enrollees under the terms of a Health Benefit Plan.
Participating Provider. A person who, under a contract directly or indirectly with Company, has agreed to provide covered Services to Members with an expectation of receiving payment, other than Copayment or Coinsurance, from Company rather than from the Member, and is either: A Participating Dentist, or A person who is regulated under state law to practice dental or dental-related Services or otherwise practicing dental care Services consistent with state law, including an expanded practice dental hygienist, denturist, or pediatric dental assistant, and who is an employee or agent of a Participating Dentist.
Participating Provider. An individual Health Care Professional, hospital, clinic, facility, entity, dentist, dental assistant, dental hygienist or any other person or organization that provides Health Care or Dental Services and that, at the time care is rendered to a Enrollee, has (or is a member of a Medical Group that has) a contract in effect with Contractor to provide Covered Services to Enrollees and accept copayments for Covered Services.
Participating Provider. All of the Health Care providers who provide covered services to TDCJ's offender patients.
Participating Provider. A Provider that has a Provider Agreement with Xxxxx Vision pertaining to payment for Covered Services rendered to a Member. This Provider may also be referred to as a "Network Provider.”
Participating Provider. A health care practitioner or entity authorized to do business in Florida and contracted with the Managed Care Plan to provide services to the Managed Care Plan’s enrollees.
Participating Provider. A hospital, physician, physician organization, Participating Physician Group, Member Physician, other health care practitioner or other organization which has a direct or indirect contractual relationship with FHS or another Participating Provider to provide Covered Services to Members. In the event PPG contracts with a health care provider to render Covered Services under this Agreement, such provider is a Participating Provider.
Participating Provider. A CHAMPUS- authorized provider that is required, or has agreed by entering into a CHAMPUS participation agreement or by act of indicating ‘‘accept assign- ment’’ on the claim form, to accept the CHAMPUS-allowable amount as the maximum total charge for a service or item rendered to a CHAMPUS bene- ficiary, whether the amount is paid for fully by CHAMPUS or requires cost- sharing by the CHAMPUS beneficiary. Part-time or intermittent home health aide and skilled nursing services. Part- time or intermittent means skilled nursing and home health aide services furnished any number of days per week as long as they are furnished (com- bined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-bay-case basis as to the need for care, less than 8 hours each day and 35 or fewer hours per week). Party to a hearing. An appealing party or parties and CHAMPUS. Party to the initial determination. In- cludes CHAMPUS and also refers to a CHAMPUS beneficiary and a partici- pating provider of services whose inter- ests have been adjudicated by the ini- tial determination. In addition, a pro- vider who has been denied approval as an authorized CHAMPUS provider is a party to that initial determination, as is a provider who is disqualified or ex- cluded as an authorized provider under CHAMPUS, unless the provider is ex- cluded based on a determination of abuse or fraudulent practices or proce- dures under another federal or xxxxx- ally funded program. See § 199.10 for ad- ditional information concerning par- ties not entitled to administrative re- view under the CHAMPUS appeals and hearing procedures.
