Anthem Plan definition
Examples of Anthem Plan in a sentence
With respect to each material Anthem Plan, Anthem has made available to Cigna, to the extent applicable, true, correct and complete copies of (1) the Anthem Plan document, including any amendments thereto, (2) the most recently prepared actuarial report or financial statements, (3) the most recent summary plan description, and all material modifications thereto, and (4) the most recent IRS determination or opinion letter.
No Anthem Plan is, or is expected to be, in “at-risk” status (within the meaning of Section 303(i)(4)(A) of ERISA or Section 430(i)(4)(A) of the Code).
The Board shall implement the Anthem Plan change effective October 1, 2011.
Anthem, Plan or their designee and Provider, where required by statute, regulation or the Health Benefit Plan, shall comply with the requirements of the Colorado prompt payment legislation, as may be applicable, for payment of Clean Claims for Covered Services.
If a reduction in or denial of payment is imposed for failure of Provider to comply with Plan's utilization management, as set forth in the provider manual(s), Provider agrees that Anthem, Plan, and Covered Individual are not responsible for the amount of such reduction or denial.
Following a request, Provider shall transfer a Member's medical records in a timely manner, or within such other time period required under applicable Regulatory Requirements, to other health care providers treating a Member at no cost to Anthem, Plan, the Member, or other treating health care providers.
Provider shall be solely responsible to pay subcontractors for any Health Services, and shall via written contract, contractually prohibit such subcontractors from billing, collecting or attempting to collect from Anthem, Plan or Members.
Notwithstanding the Out of Network Compensation provision of this Agreement, if Provider provides a Health Service to a Covered Individual for which Provider is not a designated Network/Participating Provider in a Health Services Designated Network, then Provider agrees that he/she/it shall not be reimbursed for such services by Anthem, Plan or the Covered Individual.
Requests for CARF or adjustments submitted after this date may be denied for payment, and Provider will not be permitted to ▇▇▇▇ Anthem, Plan, or the Covered Individual for those services for which payment was denied.
Notwithstanding any other provision in this Agreement, if Provider provides a Health Service to a Member for which Provider is not a designated Participating Provider in a Health Services Designated Network, then Provider agrees that he/she/it shall not be reimbursed for such services by Anthem, Plan or the Member, unless Provider was authorized to provide such Health Service by Plan.