Alternative Delivery System definition

Alternative Delivery System means any preferred provider organization, health maintenance organization, point of service, or other than traditional delivery system for vision benefits which is owned, controlled, administered or operated in whole or in part, by BCBSM, excluding BCBSM’s subsidiaries, or by any other Blue Cross and/or Blue Shield (BCBS) Plan.

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Alternative Delivery System means a health maintenance organization (HMO), preferred provider organization (PPO), exclusive provider organization (EPO), individual practice association (IPA), medical staff hospital organization (MESH), physician hospital organization (PHO), and any other plan or organization which provides health care services through a mechanism other than insurance and is regulated by the State of Mississippi.

Alternative Delivery System means a health care delivery system characterized by alliances between selected health care providers and insurers, employers, or both, managed care through greater utilization controls, or discounted fee or capitation payment arrangements with health care providers, as distinguished from the traditional fee-for-service delivery approach.

Examples of Alternative Delivery System in a sentence

• Claims submitted more than 180 days after the date(s) of service, shall not be entitled to reimbursement from either BCBSM or a Member except as set forth in Addendum G, or except as may be provided in the standard reimbursement policies or contractual arrangements between an Alternative Delivery System and its members.

• Provider will submit acceptable claims for Members’ Covered Services, and for Out-of-Panel Services unless otherwise specified by such member’s Alternative Delivery System, directly to BCBSM using BCBSM approved claim forms, direct data entry systems, tape-to-tape systems or such other methods as BCBSM may approve from time to time.

• Except for copayments and deductibles, Provider will accept the BCBSM payment as full payment for Covered Services, and for any Out-of-Panel Services unless otherwise specified by such member’s Alternative Delivery System, and agrees not to collect any further payment, except as set forth in Addendum G.

• Facility will submit acceptable claims for Members’ Covered Services, and for Out-Of-Panel services unless otherwise specified by such member's Alternative Delivery System, directly to BCBSM using BCBSM approved claim forms, direct data entry systems, tape-to-tape systems or such other methods as BCBSM may approve from time to time.

• Claims submitted more than one hundred eighty (180) days after the date(s) of service, shall not be entitled to reimbursement from either BCBSM or a Member except as set forth in Addendum G, or except as may be provided in the standard reimbursement policies or contractual arrangements between an Alternative Delivery System and its members.

• The exclusions and limitations set forth in Section 3.1. of this Article, regarding reimbursement for Out of Panel Services provided by Facility to Members of any Alternative Delivery System described in Section 1.2., are also applicable to this Section.

• Business Associate shall request, use and disclose the minimum amount of PHI necessary to accomplish the purpose of the request, use or disclosure, in accordance with 42 U.S.C. § 17935(b).

• Claims submitted more than 12 months after the date of service shall not be entitled to reimbursement from either BCBSM or a Member except as set forth in Addendum G, or except as may be provided in the standard reimbursement policies or contractual arrangements between an Alternative Delivery System and its members.

• Provider also agrees to accept, as payment in full for Covered Services and to hold member harmless, except for applicable Copayments and Deductibles, BCBSM’s approved amount for Members covered under any of BCBSM’s PPO programs, or any BCBS Traditional or PPO program if Provider provides covered Services to such Member, and for any Out-of-Panel services unless otherwise specified by such member's Alternative Delivery System, and agrees not to collect any further payment, except as set forth in Addendum G.

• Facility also agrees to accept, as payment in full for Covered Services and to hold member harmless, except for applicable Copayments and Deductibles, BCBSM’s approved amount for Members covered under any of BCBSM’s PPO programs, or any BCBS Traditional or PPO program if Facility provides covered Services to such Member, and for any Out-of-Panel Services unless otherwise specified by such member’s Alternative Delivery System, and agrees not to collect any further payment, except as set forth in Addendum F.

More Definitions of Alternative Delivery System

Alternative Delivery System means any preferred provider organization, health maintenance organization, point of service, or other than Traditional delivery system for hospice services, which is owned, controlled, administered or operated by BCBSM, excluding BCBSM’s subsidiaries, or by any other Blue Cross and/or Blue Shield (BCBS) Plan.

Alternative Delivery System means a method for administration of Product to humans other than injectable administration (e.g., pump, nasal, transdermal, sublingual, or oral administration).

Alternative Delivery System. (ADS) means any preferred provider organization, health maintenance organization, point of service or other than traditional delivery systems owned, controlled, administered or operated in whole or in part, by BCBSM or its subsidiaries, which have elected to participate in the CRNA Direct Reimbursement Program, or by any other Blue Cross and/or Blue Shield (BCBS) Plan.