Provider Participation Clause Samples
The Provider Participation clause defines the requirements and conditions under which a service provider may participate in a particular program, network, or agreement. Typically, this clause outlines eligibility criteria, application procedures, and ongoing obligations such as compliance with standards or reporting requirements. Its core practical function is to ensure that only qualified providers are included, thereby maintaining the quality and integrity of the services offered under the agreement.
Provider Participation. Contractor shall ensure that contracting physicians and other Providers from the community shall be involved as an integral part of the QIS. Contractor shall maintain and implement appropriate procedures to keep contracting Providers informed of the written QIS, its activities, and outcomes.
Provider Participation. The state must identify the criteria that will be used for reviewing provider participation in (e.g. demonstrated data collection and reporting capacity) and means of securing provider agreements for the transition.
Provider Participation. ▇▇▇▇▇▇ will notify the Contractor in writing, of providers who have been suspended or terminated from participation in the Medicaid/Medicare Program. SCDHHS or its designee may request copies of the Contractor's network listing, as specified under the reporting requirements of this Contract. Once a month SCDHHS will notify the Contractor of current Medicaid providers to assist the Contractor in care coordination and encounter data reporting. See the MHN Policy and Procedure Guide, SCDHHS Member Listing File/Provider Information Record Layout.
Provider Participation. Participant shall make known to Amplifon all Providers that may provide Covered Services to Members under this Agreement and will ensure all Providers are fully credentialed by Amplifon no later than sixty (60) days after the Provider is made known to Amplifon. Covered Services performed by Providers not fully credentialed within sixty (60) days of being made known to Amplifon may not be paid. Participant acknowledges and agrees that it shall be solely responsible for ensuring its Providers comply with Amplifon Program requirements, as documented in the Amplifon Materials and this Agreement, and Amplifon credentialing requirements, including but not limited to, continuing education credits to maintain state licensure to practice. Participant shall provide proof of continuing education credit and annual evidence of license and certification renewal of each participating Provider upon request by Amplifon.
Provider Participation. The Contractor agrees to comply with all applicable provisions of 2 CFR Part 376 (2009, as amended), pertaining to debarment and/or suspension. As a condition of enrollment, the Contractor should screen all employees and subcontractors to determine whether they have been excluded from participation in Medicare, Medicaid, the State Children’s Health Insurance Program, and/or all federal health care programs. To make this determination, the Contractor may search the LEIE website located at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇.▇▇▇/fraud/▇▇▇▇▇▇▇▇▇▇.▇▇▇. The Contractor should conduct a search of the website monthly to capture exclusions and reinstatements that have occurred since the last search and any exclusion information discovered should be immediately reported to SCDHHS. Any individual or entity that employs or contracts with an excluded provider cannot claim reimbursement from Medicaid for any items or services furnished, authorized, or prescribed by the excluded provider. This prohibition applies even when the Medicaid payment itself is made to another provider who is not excluded; for example, a pharmacy that fills a prescription written by an excluded doctor for a MHN beneficiary cannot claim reimbursement from Medicaid for that prescription. Civil monetary penalties may be imposed against providers who employ or enter into contracts with excluded individuals or entities to provide items or services to MHN beneficiaries. See Section 1128A (a) (6) of the Social Security Act and 42 CFR 1003.102(a) (2).
Provider Participation. The Contractor will within one (1) business day of receipt of such information notify the Department, in writing, of any of the Contractor’s Providers or Subcontractors who have been suspended or terminated from participation in Medicare or any Medicaid program.
Provider Participation. The execution of this Agreement shall qualify PROVIDER as a Participating Provider in the rendition of Behavioral Health Services to Members pursuant to the terms of IEHP and Health Access, as amended from time to time.
Provider Participation. Provider shall participate in those Plans designated by Optum in Plan Summaries. Optum and Plan reserve the right to determine Provider’s participation in one or more networks, even though Provider has a contract with Optum.
Provider Participation. All providers must participate in MassHealth. The Department of Public Health shall require that direct care personnel providing the ABA-based treatment will attain provisional certification prior to billing Medicaid for any direct services. Entities or individuals that have responsibility for IFSP development may not provide ABA-based treatment to a demonstration enrollee.
Provider Participation. Prior to Contract execution, the Contractor must complete the requirements and be properly enrolled as a provider in the Minnesota Health Care Programs, which includes having a current valid National Provider Identification (NPI) number. Information about enrollment can be found on the DHS website at ▇▇▇▇://▇▇▇.▇▇▇.▇▇▇▇▇.▇▇.▇▇/main/id_000090.
1. CONTRACTORS MUST ONLY OFFER MATERIALS THAT WILL BE AVAILABLE FOR THE INITIAL TERM OF THE CONTRACT. The Contractor must provide a complete line of eyeglass products and services. Participating States will confirm with the Contractor what their specific materials needs and requirements are, based on the state’s allowable benefits, at the time they issue their Participating Addendum. During the Contract term, the Contractor shall maintain adequate inventory of the contracted materials at its laboratory. This includes a sufficient inventory of all materials (frames, blank lenses, eyeglass cases, and other associated items) needed to process every properly submitted order to completion as specified in the Solicitation.