ACO Provider definition

ACO Provider means an individual or entity that bills for services under the billing number of an ACO Participant.
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Examples of ACO Provider in a sentence

  • ACO shall make new or revised policies available to Participants on the ACO Provider Portal at least thirty (30) days prior to their implementation unless those policies are changed to achieve regulatory or legal compliance for which immediate effectiveness is required.

  • Participants and Preferred Providers may submit grievances and appeal qualified ACO decisions in accordance with the ACO Appeals Policy, available on the ACO Provider Portal and incorporated herein by reference.

  • The FFS SSM returns the Shared Savings Program ACO Beneficiary SNF Waiver Response File and the Shared Savings Program ACO Provider SNF Waiver Response File to the ACO- OS, where they are picked up in the EFT Sweeps process and sent to ACO-OS RACS.

  • No Enrollee member may be an ACO Provider, an employee of an ACO Provider, or an owner of an ACO Provider.

  • The Shared Savings Program ACO Provider SNF Waiver File and Response Files are fixed- length ASCII text files.

  • The ACO-OS sends the Shared Savings Program ACO Beneficiary SNF Waiver File and the Shared Savings Program ACO Provider SNF Waiver File to FFS SSM through the CMS secured EFT Sweeps process.

  • The FFS SSM returns the Shared Savings Program ACO Beneficiary SNF Waiver Response file and the Shared Savings Program ACO Provider SNF Waiver Response file also handled by the CMS EFT process, which receives and renames files by appending a date and time to the end of the filename.

  • ACO has entered into an agreement with DVHA through which the ACO will participate in the Vermont Medicaid Next Generation Model (the “Program”), an alternative payment and population health management program with Medicaid, as described in Vermont Medicaid Next Generation Participation Agreement that will be available on the ACO Provider Portal and is incorporated by reference into this ACO Program Addendum.

  • Conditioning the participation of Practice Providers or Suppliers on referrals of Federal health care program business that the ACO, Provider, Practice Provider, or Suppliers know or should know is being (or would be) provided to Members who are not assigned to the ACO.

  • For example, an inbound response file from the FFS SSM corresponding to the Shared Savings Program ACO Provider SNF Waiver File sent December 15, 2015, at 10:30 AM would be P#EFT.ON.ACOT.PSNFRSP.HPVDC.D151215.T1030000.

Related to ACO Provider

  • New Provider means any replacement service provider or providers engaged to provide the Services (or part thereof) or substantially similar services or the Authority itself where the Services or substantially similar services or part thereof continue to be provided by the Authority after partial termination, termination or expiry of this Contract;

  • Hub Provider means an entity that (i) provides Common Channel Signaling (SS7) connectivity between the networks of service providers that are not directly connected to each other; or (ii) provides third party database services such as LIDB. The SS7 messages received by Hub Providers are accepted or rejected by the Hub Provider depending on whether a contractual arrangement exists between the Hub Provider and the message originator (sender) and whether the message originator has contracted for the type of SS7 messages being submitted for transmission to the Hub Provider.

  • Provider is any individual or company that provides professional or technical services.

  • Third Party Provider means licensors, subcontractors and suppliers of BNYM furnishing the Third Party Products.

  • Local Service Provider (LSP) is the LEC that provides retail local Exchange Service to an End User. The LSP may or may not provide any physical network components to support the provision of that End User’s service.

  • Participating Provider means an Administrator Hospital or Professional Provider which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or an Administrator facility which has been designated by the Claim Administrator as a Participating Provider.

  • Third-party logistics provider means an entity that provides

  • Services Provider means a provider of telecommunications services or other services similar to the Services, including O2 or an O2 Affiliate or any direct or indirect supplier of O2 or an O2 Affiliate;

  • Education service provider means an education management organization, school

  • Regulatory Services Provider means the organization which provides regulatory services to BSEF pursuant to a Regulatory Services Agreement.

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Financial Services Provider means any Lender and any other provider of financial services or products;

  • Training provider means an organization meeting the eligibility conditions as mentioned in Data Sheet and selected in accordance with the criteria set forth for the purpose.

  • Ambulance service provider means Latrobe Health Services recognises the following providers for the purposes of paying benefits:

  • Basic generation service provider or "provider" means a

  • Local Service Provider (LSP means the LEC that provides retail local Exchange Service to an End User. The LSP may or may not provide any physical network components to support the provision of that End User’s service.

  • financial service provider means a person engaged in the business of providing financial services in terms of authorisation issued or registration granted by a financial sector regulator;

  • Cloud Service Provider or CSP means a company or organization that offers some component of cloud computing – typically Infrastructure as a Service (IaaS), Software as a Service (SaaS) or Platform as a Service (PaaS) – to other businesses, organizations or individuals.

  • Wireless services provider means a person who provides wireless services.

  • Medical provider means a medical service provider, a hospital, a medical clinic, or a vendor of medical services.

  • Replacement Service Provider means any third party service provider appointed to perform the Services by the Purchaser from time to time.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Replacement Provider has the meaning set forth in Section II.D.1.

  • Third Party Service Provider means any consultant, agent, advisor, or independent contractor who renders services to the Company, a Subsidiary, or an Affiliate that (a) are not in connection with the offer and sale of the Company’s securities in a capital raising transaction, and (b) do not directly or indirectly promote or maintain a market for the Company’s securities.

  • Primary care provider means a participating provider who supervises, coordinates, or provides initial care or continuing care to a covered person, and who may be required by the health carrier to initiate a referral for specialty care and maintain supervision of health care services rendered to the covered person.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.