INTERWEST HEALTH PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • March 6th, 2020 • Montana
THIS AGREEMENT is made and entered into by and between InterWest Health, LLC, a Montana limited liability company (hereinafter called “InterWest”) and
Welcome toParticipating Provider Agreement • June 29th, 2015
the primary diagnosis code; (e) an indication as to whether or not dilation was performed; (f) a description of services provided (i.e. examination, materials, etc.); and (g) all necessary prescription eyewear order information (if applicable). Further, all electronically submitted claims must include PROVIDER’s National Provider Identifier (NPI) number in order to be deemed a “Clean Claim”. Any claim that does not have all of the information herein set forth may be pended or denied until all information is received from the PROVIDER and/or Member. Claims from Participating Providers under investigation for fraud or abuse and claims submitted with a tax identification number not documented on a properly W-9 form are not Clean Claims. Further, submission of a properly completed CMS Form 1500 or any applicable Uniform Claim Form and any attachments approved or adopted for use in the applicable jurisdiction for payment of Covered Services and as promulgated by the rules and regulations of
OHIOHEALTHY MEDICAL PLAN, INC. PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • April 1st, 2024
This Participating Practitioner Agreement (this "Agreement") is made effective as of the Effective Date, by and between OhioHealthy Medical Plan, Inc., OhioHealthy and ("Practitioner”) and is entered into as of the effective date set forth on the signature page of this Agreement.
CHIROPRACTIC CARE OF MINNESOTA, INC. CERTIFICATE OF MEMBERSHIP AND PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • March 24th, 2011
The undersigned chiropractor, whose licensee(s) to practice chiropractic is(are) in good standing, and all license numbers are listed below, hereby agrees to all terms, conditions and provisions of the attached CHIROPRACTIC CARE OF MINNESOTA, INC. PARTICIPATING PROVIDER AGREEMENT. By checking the box below, the undersigned chiropractor elects to participate in the HealthPartners Workers’ Compensation Addendum to this Agreement. The undersigned chiropractor further agrees and understands that this agreement shall not be given effect until it has been countersigned by the appropriate officer of Chiropractic Care of Minnesota, Inc.
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • June 5th, 2015 • Delaware
INTERWEST HEALTH PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • July 7th, 2020 • Washington
THIS AGREEMENT is made and entered into by and between InterWest Health, LLC, a Montana limited liability company (hereinafter called “InterWest”) and
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • April 26th, 2023
This Participating Provider Agreement (“Agreement”) is made and entered into this day of , (“Effective Date”), by and between (“Dentist”) and Dominion Dental Services, Inc., on behalf of itself and its applicable affiliates (“Plan”). Whenever mentioned herein, the term “Dentist” shall include all employees and agents of Dentist, including all partners, dentists, dental associates, and all staff personnel under Dentist’s direct supervision and/or control. Dentist and Plan may hereinafter be referred to individually as a “Party” and collectively as the “Parties.” The Regulatory Compliance Addendum attached to this Agreement as Exhibit A is expressly incorporated into this Agreement and is binding upon the Parties to this Agreement. In the event of any inconsistent or contrary language between the Regulatory Compliance Addendum and any other part of this Agreement, including but not limited to exhibits, attachments or amendments, the Parties agree that the provisions of the Regulatory Com
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • January 7th, 2019 • Georgia
THIS PARTICIPATING PROVIDER AGREEMENT (the “Agreement”), effective as of , 2019 (the “Effective Date”), is made and entered into by and among Zelis Network Solutions, LLC on behalf of itself and its subsidiaries and affiliates, including any and all entities under common ownership or control, with principal offices located at Two Concourse Parkway, Suite 300, Atlanta, GA 30328, (hereinafter referred to as “Network”) and “Network Provider” as defined below:
HEALTHYCT, INC. PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • April 25th, 2016 • Connecticut
and among , a Provider organized under the laws of the state of Connecticut (hereinafter “Provider”) and HealthyCT, Inc., a Connecticut nonprofit corporation (“HCT”). Hereinafter, Provider and HCT may be referred to as a “Party” or collectively, “Parties”).
OHIOHEALTHY MEDICAL PLAN, INC. PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • November 20th, 2019 • Ohio
This Participating Practitioner Agreement (this "Agreement") is made effective as of the Effective Date, by and between OhioHealthy Medical Plan, Inc., OhioHealthy and ("Practitioner”) and is entered into as of the effective date set forth on the signature page of this Agreement.
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • June 25th, 2019 • North Carolina
THIS PARTICIPATING PROVIDER AGREEMENT (“Agreement”) is made and entered into by and between WellCare Health Plans, Inc. (“WellCare”), on behalf of itself and Health Plan (as such term is defined below) and (“Contracted Provider”). WellCare, Health Plan, and Contracted Provider are sometimes referred to together as the “Parties” and individually as a “Party”.
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • November 8th, 2021
I, the undersigned (hereinafter referred to as "Provider" or "Contractor"), duly certified and participating in both the state Medicaid Program and the Federal Medicare Program, and, as applicable, duly licensed under the laws of the Commonwealth of Pennsylvania, in consideration of being enrolled by the Pennsylvania Department of Health, Chronic Renal Disease Program (hereinafter referred to as "Department" or "CRDP"), as a participating provider, do hereby agree to be legally bound as follows: I offer to and shall provide special health services pursuant to this Agreement for the Department to CRDP-eligible individuals in accordance with the restrictions indicated on the individual's CRDP identification card, make reports to the Department concerning such services, and accept compensation therefore in accordance with the terms and conditions stated or incorporated in this Agreement. This Agreement is effective as of
PARTICIPATING PROVIDER AGREEMENT WITH HIGHMARK BLUE SHIELDParticipating Provider Agreement • May 5th, 2005
Under the applicable laws of the Commonwealth of Pennsylvania, I am duly authorized to engage in the practice of . In consideration of being registered by Highmark Inc. d/b/a Highmark Blue Shield, an independent licensee of the Blue Cross and Blue Shield Association (hereinafter termed "Blue Shield"), as a participating provider, I do hereby agree as follows:
ContractParticipating Provider Agreement • July 2nd, 2015
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • February 5th, 2021
I, the undersigned (hereinafter referred to as "Provider" or "Contractor"), in consideration of being registered by the Pennsylvania Department of Health, Head Injury Program (hereinafter referred to as “Department” or “HIP”), as a participating provider, do hereby agree to be legally bound as follows: I offer to and shall provide special health services (as listed in Appendix C) for the Department to HIP-eligible individuals in accordance with the restrictions indicated in this Agreement and on the individual’s HIP funding approval letter, and shall make reports to the Department concerning such services, and shall accept compensation therefore in accordance with reimbursement policies and rates established in Appendix C by the Department and with the terms and conditions incorporated in and made a part of this Agreement. This Agreement is effective as of and is made pursuant to 35 P.S. 6934 (e), and shall continue in effect, unless otherwise terminated
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • May 5th, 2020
This Participating Provider Agreement (together with all Attachments and amendments, this “Agreement”) is made and entered by and between Mental Health Crisis Center Of Lancaster County (“Provider”) and Nebraska Total Care, Inc. (“Health Plan”) (each a “Party” and collectively the “Parties”). This Agreement is effective as of the date designated by Health Plan on the signature page of this Agreement (“Effective Date”).
PREAMBLE AND RECITALSParticipating Provider Agreement • May 23rd, 2013 • New York
to States for Medical Assistance Programs, Section 1396 et seq., as amended from time to time, or any successor program(s) thereto regardless of the name(s) thereof.
Delta Dental of Washington Participating Provider Agreement Delta Dental MedicaidParticipating Provider Agreement • April 3rd, 2019 • Washington
This Participating Provider Agreement (“Participating Provider Agreement”) is entered into by and between the undersigned provider of dental services (“Participating Provider”), and Delta Dental of Washington, a Washington nonprofit corporation (“DDWA”), and is effective when fully executed by both parties. This Agreement governs services to be delivered by Participating Providers to persons covered by the State of Washington Apple Health Dental Program (“Apple Health”) and enrolled in a managed dental care plan offered by a Contractor, as defined herein that has contracted with DDWA to obtain the services of DDWA’s Participating Providers.
Exhibit 10.40 October 30, 2002 U.S. Vision, Inc. One Harmon Drive Glendora, New Jersey 08029 Attn: William A. Schwartz Re: Amendment to Participating Provider Agreement Dear Mr. Schwartz: Reference is hereby made to that certain Participating Provider...Participating Provider Agreement • March 31st, 2006 • Refac Optical Group • Patent owners & lessors • Ohio
PARTICIPATING PROVIDER AGREEMENT for Purchase of Sublocade and Brixadi HCA Agreement Number: K Clinic Agreement Number:Participating Provider Agreement • October 31st, 2024
THIS PARTICIPATING PROVIDER AGREEMENT (Agreement) is made by and between the Washington State Health Care Authority (HCA) and the undersigned clinic (Provider), pursuant to Department of Enterprise Services Statewide Agreement #19022.
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • August 23rd, 2011 • Kentucky
THIS PARTICIPATING PROVIDER AGREEMENT (“Agreement”) is made and entered into as of (“Effective Date”) by and between WellCare Health Insurance of Illinois, Inc. d/b/a WellCare of Kentucky (“Health Plan”) and
EX1A-3 HLDRS RTS 6 f1a2018ex3-1_carolinacom.htm FORM OF PARTICIPATING PROVIDER AGREEMENT PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • May 5th, 2020
This Participating Provider Agreement (together with all Attachments and amendments, this “Agreement”) is made and entered by and among _______________________________________________________________ (“Provider”), Carolina Complete Health, Inc., a North Carolina corporation (“Health Plan”) and Carolina Complete Health Network, Inc., a Delaware corporation (“CCHN”) and subsidiary of the North Carolina Medical Society. This Agreement is effective as of the date designated by Health Plan on the signature page of this Agreement (“Effective Date”). For purposes of this Agreement, each of Provider and Health Plan (and, solely for purposes of Article VIII, CCHN) may be referred to herein as a “Party” and collectively as the “Parties.”
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • July 7th, 2023
I, the undersigned (hereinafter referred to as "Provider" or "Contractor"), in consideration of being registered by the Pennsylvania Department of Health, Head Injury Program (hereinafter referred to as “Department” or “HIP”), as a participating provider, do hereby agree to be legally bound as follows: I offer to and shall provide special health services (as listed in Appendix C) for the Department to HIP-eligible individuals in accordance with the restrictions indicated in this Agreement and on the individual’s HIP funding approval letter, and shall make reports to the Department concerning such services, and shall accept compensation therefore in accordance with reimbursement policies and rates established in Appendix C by the Department and with the terms and conditions incorporated in and made a part of this Agreement. This Agreement is effective as of and is made pursuant to 35 P.S. 6934 (e), and shall continue in effect, unless otherwise terminated according to the terms and cond
Delta Dental of Washington Participating Provider Agreement Delta Dental MedicaidParticipating Provider Agreement • May 16th, 2018 • Washington
This Participating Provider Agreement (“Participating Provider Agreement”) is entered into by and between the undersigned provider of dental services (“Participating Provider”), and Delta Dental of Washington, a Washington nonprofit corporation (“DDWA”), and is effective when fully executed by both parties. This Agreement governs services to be delivered by Participating Providers to persons covered by the State of Washington Apple Health Dental Program (“Apple Health”) and enrolled in a managed dental care plan offered by a Contractor, as defined herein that has contracted with DDWA to obtain the services of DDWA’s Participating Providers.
Participating Provider AgreementParticipating Provider Agreement • May 17th, 2018
Participating Provider, by its signature on the execution page of the Highmark Inc. d/b/a Highmark Blue Shield Participating Provider Agreement to which this Cover Page is attached, hereby certifies that the information provided in the foregoing Listing of Practitioners as prepared by Highmark Inc. d/b/a Highmark Blue Shield is accurate, true and correct. Participating Provider further understands and agrees that if it and its Practitioners are accepted as Participating Providers, participation will be governed by the terms and conditions of the Highmark Inc. d/b/a Highmark Blue Shield Participating Provider Agreement attached hereto as if all are a party thereto and the accompanying Regulations to such Participating Provider Agreement.
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • May 5th, 2020 • Nebraska
THIS PARTICIPATING PROVIDER AGREEMENT (“Agreement”) is made and entered into by and between WellCare of Nebraska, Inc. (“Health Plan”) and Lancaster County of Nebraska d/b/a Mental Health Crisis Center (“Contracted Provider”). Health Plan and Contracted Provider are sometimes referred to together as the “Parties” and individually as a “Party”.
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • July 16th, 2019 • Carolina
This Participating Provider Agreement (together with all Attachments and amendments, this “Agreement”) is made and entered by and among (“Provider”), Carolina Complete Health, Inc., a North Carolina corporation (“Carolina Complete”) and Carolina Complete Health Network, Inc., a Delaware corporation (“CCHN”) and subsidiary of the North Carolina Medical Society. This Agreement is effective as of the date designated by Carolina Complete on the signature page of this Agreement (“Effective Date”). For purposes of this Agreement, each of Provider and Carolina Complete (and, solely for purposes of Article VIII, CCHN) may be referred to herein as a “Party” and collectively as the “Parties.”
MASSACHUSETTS ACCESS TO RECOVERY PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • October 5th, 2020
(“PROVIDER”), having its legal address at and the Commonwealth of Massachusetts, Department of Public Health, Bureau of Substance Abuse Services
AMENDMENT NUMBER ONE PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • January 29th, 2018
This Amendment Number One (“Amendment”) is entered into as of March 21, 2017 by and between Nebraska Total Care, Inc. (“Health Plan”) and Mental Health Crisis Center Of Lancaster County (“Provider”), collectively referred to herein as the “Parties”.
AMENDMENT to the PARTICIPATING PROVIDER AGREEMENT between FOUNDATION HEALTH SYSTEMS AFFILIATES and PROSPECT MEDICAL GROUPParticipating Provider Agreement • May 28th, 2004 • Prospect Medical Holdings Inc • Services-offices & clinics of doctors of medicine
The Provider Services Agreement dated January 1, 1998 between Prospect Medical Group (“PPG”) and Foundation Health Systems Affiliate(s) (“FHS”) is hereby amended effective January 1, 1998.
Balance BillingParticipating Provider Agreement • February 25th, 2012
Blue Cross and Blue Shield of Texas (BCBSTX) Participating Provider Agreement prohibits providers from billing or collecting any amount from Medicaid members for health care services provided.
ADDENDUM TO AGREEMENT BETWEEN CHIROPRACTIC CARE OF MINNESOTA, INC. AND PROVIDERParticipating Provider Agreement • June 25th, 2010
This HealthPartners Workers Compensation Addendum (the “Addendum”), dated as of the date set forth on the signature page (the “Effective Date”), is an addendum to the Participating Provider Agreement (the “Agreement”) between the undersigned Provider (“Provider”) and Chiropractic Care of Minnesota, Inc., a Minnesota non-profit corporation (“CCMI”).
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • February 14th, 2024
Effective April 1, 2024 the Participating Provider Agreement (the “Agreement”) between PacificSource Community Solutions (“Health Plan”) and Central Oregon Community Mental Health Programs (“CMHPs”) is amended to include the following:
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • September 1st, 2011 • Kentucky
(“Contracted Provider”). Health Plan and Contracted Provider are sometimes referred to together as the “Parties” and individually as a “Party”.
PARTICIPATING PROVIDER AGREEMENTParticipating Provider Agreement • September 26th, 2017 • Kentucky
(“Contracted Provider”). Health Plan and Contracted Provider are sometimes referred to together as the “Parties” and individually as a “Party”.
