Downstream Entity definition

Downstream Entity means any party that enters into an agreement with CDO or with another Downstream Entity for purposes of providing services related to the agreement between CDO and CMS. The term “downstream entity” is intended to reach the entity that directly provides services to Consumers.

Downstream Entity means any party that enters into a written arrangement, acceptable to Centers for Medicare and Medicaid Services (“CMS”), with persons or entities involved with the MA benefit, below the level of the arrangement between a health plan that operates a Medicare Part C program (“MA Plan”) and a First Tier Entity. These written arrangements continue down to the level of the ultimate provider of both health and administrative services. Dental Office is a Downstream Entity of LIBERTY.

Downstream Entity has the meaning set out in 42 C.F.R. § 422.500(b) and § 423.501. Downstream Entities include any of Dentist’s subcontractors and their subcontractors down to the level of the ultimate provider of dental and administrative goods and services to MA Members.

Examples of Downstream Entity in a sentence

• Dentist shall check appropriate databases regularly, but no less than monthly and upon hiring and subcontracting, to determine whether any Affiliated Party or Downstream Entity has been suspended or excluded from participation in the Medicare program or any other federal health care program.

• Downstream Entity: any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the MA benefit, below the level of the arrangement between an MA organization (or applicant) and a first tier entity.

• Downstream Entity: any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the Medicare Advantage or Medicare Prescription Drug benefit, below the level of the arrangement between Company and a First Tier Entity.

• The Contractor may subcontract or delegate all or part of its credentialing functions when the First Tier or Downstream Entity, such as a Provider organization, maintains a formal credentialing program in compliance with the Contractor, NCQA, CMS, the Department and applicable regulatory standards.

• First Tier or Downstream Entity may not impose cost-sharing that exceeds the amount of cost-sharing that would be permitted with respect to the individual under title XIX if the individual were not enrolled in such a plan.

More Definitions of Downstream Entity

Downstream Entity means any party that enters into an agreement with a Delegated Entity or with another downstream entity for purposes of providing administrative or health care services related to the agreement between a Delegated Entity and Plan.

Downstream Entity means any party that enters into a written arrangement, acceptable to ODM, with a first tier or related entity or below the level of a first tier or related entity to provide administrative services for Ohio Medicaid- eligible individuals. These arrangements continue down to the level of the ultimate provider of the administrative services.

Downstream Entity. Any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the MA benefit, below the level of the arrangement between an MA Organization (or applicant) and a First Tier Entity. These written arrangements continue down to the level of the ultimate provider of both health care and administrative services. For purposes of this Addendum, Downstream Entity shall mean Participating Dentist.

Downstream Entity means any party that enters into a written arrangement, below the level of the arrangement between the DCO and a first-tier entity. These written arrangements continue down to the level of the ultimate provider of both health and administrative services.

Downstream Entity shall have the meaning set forth in Exhibit D, Schedule 1 of this Exhibit D.

Downstream Entity means any party that enters into an agreement with Recipient or with another Downstream Entity for purposes of providing services related to the Navigator grant. The term “downstream entity” is intended to reach the entity that directly provides services to Consumers.

Downstream Entity means any party that enters into an agreement with a Delegated Entity or with another Downstream Entity for purposes of providing administrative or health care services related to the agreement between the Delegated Entity and the QHP Issuer. The term Downstream Entity is intended to reach the entity that directly provides administrative services or health care services to qualified individuals, qualified employers, or qualified employees and their dependents.