Contracted Provider Dispute definition

Contracted Provider Dispute means a contracted provider’s written notice to VOC challenging, appealing or requesting reconsideration of a claim (or a bundled group of substantially similar multiple claims that are individually numbered) that has been denied, adjusted or contested or seeking resolution of a billing determination or other contract dispute (or bundled group of substantially similar multiple billing or other contractual disputes that are individually numbered) or disputing a request for reimbursement of an overpayment of a claim.
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Contracted Provider Dispute means a contracted provider's written notice to the plan or the plan's capitated provider challenging, appealing or requesting reconsideration of a claim (or a bundled group of substantially similar multiple claims that are individually numbered) that has been denied, adjusted or contested or seeking resolution of a billing determination or other contract dispute (or a bundled group of substantially similar multiple billing or other contractual disputes that are individually numbered) or disputing a request for reimbursement of an overpayment of a claim that contains, at a minimum, the following information: the provider's name; the provider's identification number; contact information; and:
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Contracted Provider Dispute means a contracted provider’s written notice to the
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Examples of Contracted Provider Dispute in a sentence

  • Sending a Contracted Provider Dispute to IPA Contracted provider disputes submitted to IPA must include the information listed in Section II.A, above, for each contracted provider dispute.

  • Substantially similar multiple claims, billing or contractual disputes, may be filed in batches as a single dispute, provided that such disputes are submitted in the following format: • Sort provider disputes by similar issue • Provide cover sheet for each batch • Number each cover sheet • Provide a cover letter for the entire submission describing each provider dispute with references to the numbered coversheet Time Period for Resolution and Written Determination of Contracted Provider Dispute.

  • Time Period for Resolution and Written Determination of Contracted Provider Dispute.

  • Sending a Contracted Provider Dispute to IPA‌ Contracted provider disputes submitted to IPA must include the information listed in Section II.A, above, for each contracted provider dispute.

  • If the contracted provider dispute involves an enrollee or group of enrollees, the name and identification number(s) of the enrollee or enrollees, a clear explanation of the disputed item, including the Date of Service and provider’s position on the dispute, and an enrollee’s written authorization for provider to represent said enrollees.2. Sending a Contracted Provider Dispute to HEALTH CARE LA, IPA.

Related to Contracted Provider Dispute

  • Technical Dispute has the meaning specified in Section 12.2;

  • Contracted Processor means a Subprocessor;

  • Reconciliation Dispute has the meaning set forth in Section 7.9 of this Agreement.

  • trade dispute means any dispute or difference between employers and workmen, or between workmen and workmen, connected with the employment or non-employment, or the terms of employment, or with the conditions of labour, of any person;

  • Approved provider means a provider of services registered with the appropriate association or organization to render services to a member and approved by Latrobe to render services to its members.

  • Designated provider means a person who:

  • Qualified provider means a person or business experienced in the design, implementation, and installation of energy conservation measures. A qualified provider to whom the contract is awarded shall give a sufficient bond to the municipality for its faithful performance.

  • Applied Provider Advance has the meaning assigned to such term in Section 2.06(a).

  • Contracted Services means covered services that are to be provided by the Contractor under the terms of this Contract.

  • Agreement Disputes shall have the meaning set forth in Section 10.1.

  • Recognised Provider (Approved Provider) means a provider of services registered with the appropriate association or organization to render services to a member and approved Latrobe to render services to its members.

  • Preferred Provider or “Network Provider” means a doctor, hospital, medical facility or other provider of health care which is included in a network which has been designated by the Fund to render health related services to Fund participants.

  • Related provider trust means a titling trust or other trust established by a licensed viatical settlement provider or a financing entity for the sole purpose of holding the ownership or beneficial interest in purchased policies in connection with a financing transaction. The trust shall have a written agreement with the licensed viatical settlement provider under which the licensed viatical settlement provider is responsible for ensuring compliance with all statutory and regulatory requirements and under which the trust agrees to make all records and files related to viatical settlement transactions available to the commissioner as if those records and files were maintained directly by the licensed viatical settlement provider.

  • Preferred Provider Organization (PPO) means a health insurance issuer's or carrier's insurance policy that offers covered health care services provided by a network of providers who are contracted with the issuer or carrier (“in-network”) and providers who are not part of the provider network (“out-of-network”).

  • Provider contract means any contract between a provider and a carrier (or a carrier's network,

  • Bona fide physician-patient relationship means a treatment or counseling relationship between a physician and patient in which all of the following are present:

  • Dispute Resolution Process means the process described in clause 9

  • Contracted vendor means any person, persons, or entity under contract or agreement with the HCA to provide goods or services for the provision or administration of PEBB benefits. The term "contracted vendor" includes subcontractors of the HCA and subcontractors of any person, persons, or entity under contract or agreement with the HCA that provide goods or services for the provision or administration of PEBB benefits.

  • Contracted Vendors means all vendors who contract or who have contracted with the Owners pursuant to Bid No. 23-056 for Unit Price – Plumbing Services.

  • Unapplied Provider Advance means any Provider Advance other than an Applied Provider Advance.

  • Subject Matter Expert means a person who has working or expert knowledge about a particular topic or field.

  • Dispute means any dispute, controversy, claim or difference of whatever nature arising out of, relating to, or having any connection with this Agreement, including a dispute regarding the existence, formation, validity, interpretation, performance or termination of this Agreement or the consequences of its nullity and also including any dispute relating to any non-contractual rights or obligations arising out of, relating to, or having any connection with this Agreement.

  • Affiliated provider means a health professional, licensed hospital, licensed pharmacy, or any other institution, organization, or person that has entered into a participating provider contract, directly or indirectly, with a health maintenance organization to render 1 or more health services to an enrollee. Affiliated provider includes a person described in this subdivision that has entered into a written arrangement with another person, including, but not limited to, a physician hospital organization or physician organization, that contracts directly with a health maintenance organization.

  • Lockbox Processor means Regulus Group II LLC, or its successors or assigns.

  • Disputed Items has the meaning specified in Section 2.7(c).

  • Disputed Item has the meaning set forth in Section 2.04(b).