CHIP Eligible Individual definition

CHIP Eligible Individual means any individual who has been certified by the Utah Department of Human Services or the Utah Department of Workforce Services to be eligible for CHIP benefits. Claim includes (1) a bill for services, (2) a line item of services, or (3) all services for one Enrollee within a bill. Clean Claim means a claim that can be processed without obtaining any additional information from the Provider of the service or from a third party. It includes a claim with errors originating from the Contractor’s claims system. It does not include a claim from a Provider who is under investigation for Fraud or Abuse or a claim under review for medical necessity. CMS means the Centers for Medicare and Medicaid Services, the federal Medicaid agency, within the Department of Health and Human Services. Cold Call Marketing means any unsolicited personal contact by the Contractor, its employees, Participating Providers, agents, or subcontractors with a potential enrollee for the purposes of marketing. Confidential Data means any non-public information maintained in an electronic format used or exchanged by the Parties in the course of the performance of this contract whose collection, disclosure, protection, and disposition is governed by state or federal law or regulation, particularly information subject to the Xxxxx-Xxxxx-Xxxxxx Act, the Health Insurance Portability and Accountability Act, and other equivalent state and federal laws. Confidential Data includes, but is not limited to, social security numbers, birth dates, medical records, Medicaid/CHIP identification numbers, dental claims and Encounter Data. Contractor Affiliate means an entity who conducts provider network activities on behalf of the Contractor and is an entity that is under common control with, controlling or controlled by Contractor. Convicted means a judgment of conviction entered by a Federal, State, or local court, regardless of whether an appeal from that judgment is pending. Covered Services means services identified in Attachment C of this Contract which the Contractor has agreed to provide to Enrollees and pay for under the terms of this Contract.
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CHIP Eligible Individual means any individual who has been certified by the Utah Department of Human Services or the Utah Department of Workforce Services to be eligible for CHIP benefits. Claim means (1) a bill for services, (2) a line item of services, or (3) all services for one Enrollee within a bill. Clean Claim means a claim that can be processed without obtaining any additional information from the Provider of the service or from a third party. It includes a claim with errors originating from the Contractor’s claims system. It does not include a claim from a Provider who is under investigation for Fraud or Abuse or a claim under review for medical necessity. CMS means the Centers for Medicare and Medicaid Services, the federal Medicaid agency, within the Department of Health and Human Services. Cold Call Marketing means any unsolicited personal contact by the Contractor, its employees, Network Providers, agents, or subcontractors with a potential enrollee for the purposes of marketing. Comprehensive Risk Contract means a risk contract between the State and an MCO that covers comprehensive services, that is, inpatient hospital services and any of the following services, or any three or more of the following services:
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CHIP Eligible Individual means any individual who has been certified by the Utah Department of Human Services or the Utah Department of Workforce Services to be eligible for CHIP benefits. Claim includes (1) a bill for services, (2) a line item of services, or (3) all services for one Enrollee within a bill. Clean Claim means a claim that can be processed without obtaining any additional information from the Provider of the service or from a third party. It includes a claim with errors originating from the Contractor’s claims system. It does not include a claim from a Provider who is under investigation for Fraud or Abuse or a claim under review for medical necessity. Cold Call Marketing means any unsolicited personal contact by the Contractor, its employees, Network Providers, agents, or subcontractors with a potential enrollee for the purposes of marketing. Comprehensive Risk Contract means a risk contract between the State and an MCO that covers comprehensive services, that is, inpatient hospital services and any of the following services, or any three or more of the following services:
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Examples of CHIP Eligible Individual in a sentence

  • Amendments, revisions, or additions to the CHIP State Plan or to State or Federal regulations, guidelines, or policies, insofar as they affect the scope or nature of benefits available to a CHIP Eligible Individual shall be considered incorporated by this Contract and the Contractor shall be required to provide those benefits to CHIP Eligible Individuals.

  • Amendments, revisions, or additions to the State Plan or to State or Federal regulations, guidelines, or policies, insofar as they affect the scope or nature of benefits available to a CHIP Eligible Individual shall be considered incorporated by this Contract and the Contractor shall be required to provide those benefits to CHIP Eligible Individuals.

  • For Covered Services other than inpatient, medical equipment and organ transplantations, if authorization has been given for a Covered Service and a CHIP Eligible Individual transitions between Health Plans or Fee-For-Service prior to the delivery of such Covered Service, the receiving Health Plan shall be bound by the relinquishing Health Plan’s prior authorization for 90 days.


More Definitions of CHIP Eligible Individual

CHIP Eligible Individual means any individual who has been certified by the Utah Department of Human Services or the Utah Department of Workforce Services to be eligible for CHIP benefits. Managing Employee means a general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of the Contractor. Marketing means any communication from Contractor, its employees, Participating Providers, agents or subcontractors to a potential enrollee that can reasonably be interpreted to influence the potential Marketing Materials means materials that are produced in any medium, by or on behalf of the Contractor, its employees, affiliated Providers, agents or subcontractors to a potential enrollee that can reasonably be intended to market to potential enrollees.
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CHIP Eligible Individual means any individual who has been certified by the Utah Department of Human Services or the Utah Department of Workforce Services to be eligible for CHIP benefits. Claim includes (1) a bill for services, (2) a line item of services, or (3) all services for one Enrollee within a bill. Clean Claim means a claim that can be processed without obtaining any additional information from the Provider of the service or from a third party. It includes a claim with errors originating from the Contractor’s claims system. It does not include a claim from a Provider who is under investigation for Fraud or Abuse or a claim under review for medical necessity. CMS means the Centers for Medicare and Medicaid Services, the federal Medicaid agency, within the Department of Health and Human Services. Cold Call Marketing means any unsolicited personal contact by the Contractor, its employees, Participating Providers, agents, or subcontractors with a potential enrollee for the purposes of marketing. Confidential Data means any non-public information maintained in an electronic format used or exchanged by the Parties in the course of the performance of this contract whose collection, Convicted means a judgment of conviction entered by a Federal, State, or local court, regardless of whether an appeal from that judgment is pending. Covered Services means services identified in Attachment C of this Contract which the Contractor has agreed to provide and pay for under the terms of this Contract.
Sample 1
CHIP Eligible Individual means any individual who has been certified by the Utah Department of Human Services or the Utah Department of Workforce Services to be eligible for CHIP benefits. Managing Employee means a general manager, business manager, administrator, director, or other individual who exercises operational or managerial control over, or who directly or indirectly conducts the day-to-day operation of the Contractor. Marketing means any communication from Contractor, its employees, Participating Providers, agents or subcontractors to a potential enrollee that can reasonably be interpreted to influence the potential enrollee to enroll in Contractor’s CHIP product, or either to not enroll in, or to disenroll from an another Health Plan’s CHIP product. Marketing Materials means materials that are produced in any medium, by or on behalf of the Contractor, its employees, affiliated Providers, agents or subcontractors to a potential enrollee that can reasonably be intended to market to potential enrollees.
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Related to CHIP Eligible Individual

  • Eligible Individual means any person who is an Employee, a Consultant or a Non-Employee Director, as determined by the Administrator.

  • Eligible Individuals means directors, officers, employees and consultants of the Company or any of its Subsidiaries or Affiliates, and prospective employees and consultants who have accepted offers of employment or consultancy from the Company or its Subsidiaries or Affiliates.

  • Eligible Person means individuals, corporations, trusts, the estates of deceased individuals, partnerships and unincorporated associations of persons;

  • Full Value Award means an Award other than in the form of an ISO, NQSO, or SAR, and which is settled by the issuance of Shares.

  • Section 162(m) Participant means any key Employee designated by the Administrator as a key Employee whose compensation for the fiscal year in which the key Employee is so designated or a future fiscal year may be subject to the limit on deductible compensation imposed by Section 162(m) of the Code.

  • Eligible Participant means an employee, officer, consultant or director of the Company or any Affiliate.

  • Nonemployee Director Award means any Award granted to a Nonemployee Director.

  • U.S. Participant means a Participant who is a citizen of the United States or a resident of the United States, as defined in section 7701(a)(30)(A) and section 7701(b)(1) of the Code and any other Participant who is subject to tax under the Code with respect to compensatory awards granted pursuant to the Plan;

  • Eligible Persons or “Households” means one or more natural persons or a family who pays 30 percent of their household income toward their monthly rent and is determined by Grantee to be eligible for rental assistance under this Agreement.

  • Covered Employee means an employee who is a “Covered Employee” within the meaning of Section 162(m) of the Code.

  • Key Individual means any individual ultimately responsible for establishing or directing policies and procedures of the licensee, such as an executive officer, manager, director, or trustee.

  • Other Stock or Cash Based Awards means cash awards, awards of Shares, and other awards valued wholly or partially by referring to, or are otherwise based on, Shares or other property.

  • Section 16 Participant means a participant under the Plan who is then subject to Section 16 of the Exchange Act.

  • Qualified Performance-Based Award means an Award intended to qualify for the Section 162(m) Exemption, as provided in Section 11.

  • Other Stock or Cash Based Award means a cash payment, cash bonus award, stock payment, stock bonus award, performance award or incentive award that is paid in cash, Shares or a combination of both, awarded under Section 9.1, which may include, without limitation, deferred stock, deferred stock units, performance awards, retainers, committee fees, and meeting-based fees.

  • Eligible Participants means persons who, at a particular time, are employees, officers, consultants, or directors of the Company or its subsidiaries;

  • Employee Participant means an Employee who holds an outstanding Award under the terms of the Plan.

  • Qualified Participant means an individual who is a participant of Tier 2 and who meets 1 of the following requirements:

  • Eligible Recipient means an employee, director or independent contractor of the Company or any Affiliate of the Company who has been selected as an eligible participant by the Administrator; provided, however, to the extent required to avoid accelerated taxation and/or tax penalties under Section 409A of the Code, an Eligible Recipient of an Option or a Stock Appreciation Right means an employee, non-employee director or independent contractor of the Company or any Affiliate of the Company with respect to whom the Company is an “eligible issuer of service recipient stock” within the meaning of Section 409A of the Code.

  • Appreciation Award means any Award under this Plan of any Stock Option, Stock Appreciation Right or Other Stock-Based Award, provided that such Other Stock-Based Award is based on the appreciation in value of a share of Common Stock in excess of an amount equal to at least the Fair Market Value of the Common Stock on the date such Other Stock-Based Award is granted.

  • Non-U.S. Participant means any Participant that if it were a Lender would qualify as a Non-U.S. Lender.

  • Eligible Recipients means all Employees, all Non-Employee Directors and all Consultants.

  • Cash-Based Award means an Award entitling the recipient to receive a cash-denominated payment.

  • Covered Participant means a Participant who is a “covered employee” as defined in Section 162(m)(3) of the Code, and the regulations promulgated thereunder, and any individual the Committee determines should be treated as such a covered employee.

  • Eligible Employee means full-time and part-time employees in the bargaining unit who have completed four hundred and fifty (450) hours of service and who are not prohibited from contributing to the Plan by legislation or the Plan rules because of their age or because they are in receipt of a pension from the Plan.

  • Eligible Directors means, with respect to a Regulated Fund and a Potential Co-Investment Transaction, the members of the Regulated Fund’s Board eligible to vote on that Potential Co-Investment Transaction under Section 57(o) of the Act (treating any registered investment company or series thereof as a BDC for this purpose).