Government Sponsored Programs Provider definition

Government Sponsored Programs Provider means those providers of health care services who/which have entered into a Government Sponsored Programs Agreement with Blue Shield or a participant in another network, as designated by Highmark, to cover Government Sponsored Program products.
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Examples of Government Sponsored Programs Provider in a sentence

  • Where required by Act 68, Blue Shield will notify Government Sponsored Programs Provider in writing at least thirty (30) days before it implements any changes to its contracts, policies or procedures affecting Government Sponsored Programs Provider or the provision or payment of health care services to Members unless the change is required by Law.

  • Government Sponsored Programs Provider will adhere to all Laws applicable to the provision of professional health care services under this Agreement.

  • Payment for Covered Services provided to Members under the Government Sponsored Programs Provider Agreement may be derived in whole or in part from federal funds.

  • Government Sponsored Programs Provider shall have the right to appeal a suspension or termination initiated by Blue Shield based upon cause.

  • Such appeals shall be in writing and shall be addressed to the Blue Shield credentialing committee if the suspension or termination arose in connection with the recredentialing of Government Sponsored Programs Provider or any of its Practitioners.

  • Each Practitioner meets and will continue throughout the Term to meet all credentialing and recredentialing requirements as established by Blue Shield for participation as a Government Sponsored Programs Provider in the Government Sponsored Programs Provider network and as set forth in the Administrative Requirements.

  • All matters, disputes or controversies relating to the services performed by Government Sponsored Programs Providers or any questions involving professional ethics (including determinations of any Blue Shield committee that a Government Sponsored Programs Provider disputes) shall be considered and determined only by the Review Committee in the manner provided by the applicable provisions in the Bylaws and the Review Committee Guidelines, which are included in the BSOM or its successor.

  • Unless a longer time period is required by applicable statutes or regulations, Government Sponsored Programs Provider shall maintain such records and any related contracts for ten (10) years.

  • Blue Shield may, on consideration of applicable credentialing criteria or other reasons, pertaining to cost effectiveness, quality of care or other factors, refuse to permit the participation of Provider as a Government Sponsored Programs Provider in its sole discretion.

  • Blue Shield may reject an application to be a Government Sponsored Programs Provider, or may terminate the participation as a Government Sponsored Programs Provider, in accordance with the terms of the Government Sponsored Programs Provider Agreement, these Regulations and/or Administrative Requirements.

Related to Government Sponsored Programs Provider

  • Government Programs means (i) the Medicare and Medicaid Programs, (ii) the United States Department of Defense Civilian Health Program for Uniformed Services and (iii) other similar foreign or domestic Federal, state or local reimbursement or governmental health care programs.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Dependent care assistance program means a benefit plan

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Non-Administrator Coordinated Home Care Program means a Coordinated Home Care Program which does not have an agreement with the Claim Administrator or a Blue Cross Plan but has been certified as a home health agency in accordance with the guidelines established by Medicare.

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Participating Retail Health Clinic means a Retail Health Clinic which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Covered Government support contractor means a contractor (other than a litigation support contractor covered by 252.204-7014) under a contract, the primary purpose of which is to furnish independent and impartial advice or technical assistance directly to the Government in support of the Government’s management and oversight of a program or effort (rather than to directly furnish an end item or service to accomplish a program or effort), provided that the contractor—

  • Service and support administrator means a person, regardless of title, employed by or under contract with a county board to perform the functions of service and support administration and who holds the appropriate certification in accordance with rule 5123:2-5-02 of the Administrative Code.

  • Child Care Program means a person or business that offers child care.

  • Diagnostic clinical procedures manual means a collection of written procedures that describes each method (and other instructions and precautions) by which the licensee performs diagnostic clinical procedures; where each diagnostic clinical procedure has been approved by the authorized user and includes the radiopharmaceutical, dosage, and route of administration.

  • AML Program has the meaning ascribed thereto in Schedule 2.1(F)(8) hereof.

  • Family child care provider means a person who: (a) Provides

  • Participating Orthotic Provider means an Orthotic Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.

  • CRAF Program means the Civil Reserve Air Fleet Program authorized under 10 U.S.C. Section 9511 et seq. or any similar or substitute program under the laws of the United States.

  • Educational program means a program for educating and preparing physician assistants which is approved by the board.

  • Independent educational evaluation means an evaluation conducted by a qualified examiner who is not employed by the public agency responsible for the education of the child in question.

  • Non-Participating Retail Health Clinic means a Retail Health Clinic which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • OFAC Sanctions Programs means all laws, regulations, and Executive Orders administered by OFAC, including without limitation, the Bank Secrecy Act, anti-money laundering laws (including, without limitation, the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001, Pub. L. 107-56 (a/k/a the USA Patriot Act)), and all economic and trade sanction programs administered by OFAC, any and all similar United States federal laws, regulations or Executive Orders, and any similar laws, regulators or orders adopted by any State within the United States.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.