Provider Agreement. I declare that I have read and understood the requirements as stated in this document and I agree to comply with these requirements. I further declare that all of the information I have provided on this form is true and correct to the best of knowledge. I agree to notify the county within 10 calendar days if any of the information I have provided in this Provider Workweek and Travel time Agreement changes, and depending on what information has changed, I may be required to complete a new SOC 2255.
Provider Agreement a written agreement between a provider as defined under of this Article and the PACE organization or a subcontractor to provide services to the PACE organization's members.
Provider Agreement. The department may refuse to enter into or may revoke the Child Care Assistance Provider Agreement, Form 470-3871 or 470-3871(S), if any of the following occur:
a. The department finds a hazard to the safety and well-being of a child, and the provider cannot or refuses to correct the hazard.
b. The provider has submitted claims for payment for which the provider is not entitled.
c. The provider fails to cooperate with an investigation conducted by the department of inspections and appeals to determine whether information the provider supplied to the department regarding payment for child care services is complete and correct. Once the agreement is revoked for failure to cooperate, the department shall not enter into a new agreement with the provider until cooperation occurs.
d. The provider does not meet one of the applicable requirements set forth in subrule 170.4(3).
e. The provider fails to comply with any of the terms and conditions of the Child Care Assistance Provider Agreement, Form 470-3871 or 470-3871(S).
f. The provider submits attendance documentation for payment and the provider knows or should have known that the documentation is false or inaccurate.
g. An overpayment of CCA funds with a balance of $3,000 or more exists for a provider and that provider fails to enter into a repayment agreement with the department of inspections and appeals (DIA) or does not make payments according to the repayment agreement on file with DIA.
h. The provider is found to have more children in care at one time than allowed for the provider type as found at rule 441—110.6(237A) and 441—subrules 110.13(1), 110.14(1), 110.15(1), 120.6(1) and 170.4(3).
Provider Agreement. Except for an employment agreement between a provider and health maintenance organization, an agreement to provide health care services between a provider and a health maintenance organization entered into or renewed after April 25, 1988, must contain the following provision: PROVIDER AGREES NOT TO BILL, CHARGE, COLLECT A DEPOSIT FROM, SEEK REMUNERATION FROM, OR HAVE ANY RECOURSE AGAINST AN ENROLLEE OR PERSONS ACTING ON THEIR BEHALF FOR SERVICES PROVIDED UNDER THIS AGREEMENT. THIS PROVISION APPLIES TO BUT IS NOT LIMITED TO THE FOLLOWING EVENTS: (1) NONPAYMENT BY THE HEALTH MAINTENANCE ORGANIZATION OR (2) BREACH OF THIS AGREEMENT. THIS PROVISION DOES NOT PROHIBIT THE PROVIDER FROM COLLECTING CO-PAYMENTS OR FEES FOR UNCOVERED SERVICES. THIS PROVISION SURVIVES THE TERMINATION OF THIS AGREEMENT FOR AUTHORIZED SERVICES PROVIDED BEFORE THIS AGREEMENT TERMINATES, REGARDLESS OF THE REASON FOR TERMINATION. THIS PROVISION IS FOR THE BENEFIT OF THE HEALTH MAINTENANCE ORGANIZATION ENROLLEES. THIS PROVISION DOES NOT APPLY TO SERVICES PROVIDED AFTER THIS AGREEMENT TERMINATES. THIS PROVISION SUPERSEDES ANY CONTRARY ORAL OR WRITTEN AGREEMENT EXISTING NOW OR ENTERED INTO IN THE FUTURE BETWEEN THE PROVIDER AND THE ENROLLEE OR PERSONS ACTING ON THEIR BEHALF REGARDING LIABILITY FOR PAYMENT FOR SERVICES PROVIDED UNDER THIS AGREEMENT.
Provider Agreement. The department may refuse to enter into or may revoke the Child Care Assistance Provider Agreement, Form 470-3871, if:
a. The department finds a hazard to the safety and well-being of a child, and the provider cannot or refuses to correct the hazards; or
b. The provider has submitted claims for payment for which the provider is not entitled; or
c. The provider fails to cooperate with an investigation conducted by the department of inspections and appeals to determine whether information the provider supplied to the department regarding payment for child care services is complete and correct. Once the agreement is revoked for failure to cooperate, the department shall not enter into a new agreement with the provider until cooperation occurs.
Provider Agreement. I agree to:
1. Perform appropriate components of EPSDT screenings in adherence with the current AAP Bright Futures periodicity schedule.
2. Refer EPSDT-eligible beneficiaries to other Division of Medicaid (DOM) enrolled licensed practitioners, of the beneficiary’s choice, for services necessary to correct or ameliorate physical, mental, psychosocial and/or behavioral health conditions discovered by the screening services, whether or not such services are covered under DOM State Plan.
3. Seek reimbursement only for EPSDT screening(s) if the EPSDT screening(s) have been provided in accordance with DOM policies and the AAP Bright Futures’ periodicity schedule.
4. Permit the provider’s name to be listed as an EPSDT screening provider with the DOM program and consent to inclusion on a provider list made available to DOM Regional Office staff for selection by eligible beneficiaries.
5. Document in the medical record the specific age appropriate screening requirements in accordance with the AAP Bright Futures periodicity schedule and as outlined in Miss. Admin Code Part 223, Rule 1.6: Documentation Requirements for EPSDT Screenings.
6. Follow-up on all referred cases and document whether or not the initial referral visit was kept by the beneficiary.
Provider Agreement. The Participating Provider Agreement governing each Provider’s participation in the Plan, which is located at xxxxx://xxxxxxxx.xxx/participating-provider- agreement.
Provider Agreement. The Provider must have in effect a written Provider Agreement with the Department that has been properly executed and is in effect.
Provider Agreement. The provider participation agreement between Humana and Hospital to serve Humana’s Members. This Attachment is attached to the Agreement. For purposes of this Attachment, “affiliate” means, when used with reference to a specific Humana Inc. organization, directly or indirectly, through one or more intermediaries, controls, is controlled by, or is under common control with Humana Inc. Under this Agreement, Humana Wisconsin Health Organization Insurance Corporation is an affiliate and licensee of the Oklahoma Insurance Department authorized to transact business within the State of Oklahoma.
Provider Agreement. Those agreements between Company and Providers for the provision of Internet text searching capabilities, comparison shopping capabilities, contextual advertisements, or banner advertisements through Programs.
