Managed Care Agreements definition

Managed Care Agreements shall have the meaning set forth in Section 5.8(c).
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Managed Care Agreements mean written contracts between IPA and the Payers.
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Managed Care Agreements means any and all contracts, agreements, letters of agreement, memoranda of understanding, or any like written or oral agreement (hereinafter referred to as "Managed Care Agreement"), with any insurer, managed care company or any other third-party payor (hereinafter collectively referred to as "Payor") which is obligated to pay for behavioral health care benefits for any person pursuant to a Payor benefit contract with such person, and under which such Managed Care Agreements such behavioral health services are provided for a negotiated reimbursement rate. The parties agree that for the purposes of this Master Franchise Agreement, Managed Care Agreements shall not include any agreement for the provision of behavioral health care services solely with a county or a local employee assistance program with services provided by a single OpCo subsidiary. The parties acknowledge that Franchisor or a subsidiary of Franchisor shall subcontract with OpCo to provide staffing to service and negotiate such Managed Care Agreements; provided, however, that Franchisor shall retain the right to determine which, if any, Managed Care Agreement shall be entered into in Franchisor's name. Franchisor shall use commercially reasonable best efforts, subject to applicable law, to cause OpCo Franchisees to have "preferred provider" status in connection with Franchisor's managed behavioral healthcare business on a basis substantially consistent with existing covenants, terms and conditions, unless the customer directs otherwise.
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Examples of Managed Care Agreements in a sentence

  • Refrain from soliciting, attempting to solicit, or otherwise encouraging, in any manner whatsoever, any third party payer (including the Payers) to terminate a contract (including the Managed Care Agreements) with IPA, to refuse to enter into a contract with IPA, or to refuse to renew an existing contract with IPA.

  • PROVIDER hereby consents upon notice from IPA to an amendment to this Agreement made necessary or desirable by the terms of the Managed Care Agreements, the Act, or any rule or regulation promulgated under the Act or by the Department.


More Definitions of Managed Care Agreements

Managed Care Agreements mean written contracts between IPA and the Payers. 1.33 “Medically Necessary” means the performance of Ancillary Services that are: a. In accordance with generally accepted medical practice standards prevailing in the applicable professional community at the time of treatment, b. In conformity with the professional and technical standards adopted by the Payers, if any, c. Consistent with the physician order and diagnosis, 4 d. Not furnished primarily for the convenience of the Enrollee, Physician Contractor or Facility, and e. Furnished at the most appropriate level that can be provided safely and effectively to the Enrollee. 1.34 “Location” 000 Xxxxx Xxx., Xxxx X, Xxxxxxxx, XX 00000 1.35 “Non-Defaulting Party” means the party alleging a breach of a material term of this Agreement. 1.36 “Payers” mean health maintenance organizations and plans licensed under the Act. 1.37 “Personnel” mean allied health professionals and paramedical and support personnel. 1.38 “Physician Contractors” mean physicians and groups of physicians with which IPA contracts to furnish professional medical, surgical and related ancillary services to Enrollees. 1.39 “Property Insurance” means the policy or policies of insurance described in Section 6.01 (ii) of this Agreement. 1.40 “PROVIDER” means Effective Health Inc., dba Sespe Pharmacy 1.41 “Rehabilitated Claim” means a Clean Claim submitted by or on behalf of PROVIDER in response to the receipt of the Rejected Claim. 1.42 “Rejected Claim” means a written claim from or on behalf of PROVIDER that contains some but not all of the information and/or documentation required of a Clean Claim, or that contains erroneous information and/or documentation. 1.43 “Review Programs” mean the professional review programs that IPA may adopt or amend from time to time. 1.44 “Subject Claim” means an otherwise Clean Claim submitted in a timely manner by PROVIDER and for which IPA denies reimbursement, in whole or in part. 1.45 “Tangible Items” mean physical space, equipment, furniture, furnishings, instruments and medical and office supplies. 1.46 “Treatment Protocols” mean the clinical protocols developed and/or amended by IPA from time to time for the conservative treatment of medical conditions. 1.47 “Untimely Claim” means a Clean Claim submitted after the time period specified in Section 4.02 below, and. a Rehabilitated Claim submitted after the time period specified in Section 4.07 below. 5 1.48 “UR/QI Programs” mean the utilization review and q...
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Managed Care Agreements means a contract between any Obligor and a health maintenance organization.
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Related to Managed Care Agreements

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

  • 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.

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other entity administering the Medicaid program and a health care operation under which the health care operation agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • Managed care entity means either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

  • Provider Agreements means all participation, provider and reimbursement agreements or arrangements now or hereafter in effect for the benefit of Tenant or any Manager in connection with the operation of any Facility relating to any right of payment or other claim arising out of or in connection with Tenant’s participation in any Third Party Payor Program.

  • Managed care means a system that provides the coordinated delivery of services and supports that are necessary and appropriate, delivered in the least restrictive settings and in the least intrusive manner. Managed care seeks to balance three factors:

  • 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.

  • 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.

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

  • Third Party Agreements means any Contract between or among a Party (or any member of its Group) and any other Persons (other than the Parties or any member of their respective Groups) (it being understood that to the extent that the rights and obligations of the Parties and the members of their respective Groups under any such Contracts constitute Versum Assets or Versum Liabilities, or Air Products Retained Assets or Air Products Retained Liabilities, such Contracts shall be assigned or retained pursuant to Article II).

  • 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.

  • Managed health care system means: (a) Any health care

  • Collaborative pharmacy practice agreement means a written and signed

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Health care facilities means buildings, structures, or equipment suitable and intended for, or incidental or ancillary to, use in providing health services, including, but not limited to, hospitals; hospital long-term care units; infirmaries; sanatoria; nursing homes; medical care facilities; outpatient clinics; ambulatory care facilities; surgical and diagnostic facilities; hospices; clinical laboratories; shared service facilities; laundries; meeting rooms; classrooms and other educational facilities; students', nurses', interns', or physicians' residences; administration buildings; facilities for use as or by health maintenance organizations; facilities for ambulance operations, advanced mobile emergency care services, and limited advanced mobile emergency care services; research facilities; facilities for the care of dependent children; maintenance, storage, and utility facilities; parking lots and structures; garages; office facilities not less than 80% of the net leasable space of which is intended for lease to or other use by direct providers of health care; facilities for the temporary lodging of outpatients or families of patients; residential facilities for use by the aged or disabled; and all necessary, useful, or related equipment, furnishings, and appurtenances and all lands necessary or convenient as sites for the health care facilities described in this subdivision.

  • 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.

  • Customer Agreement means a written agreement entered into between Provider and any Customer pursuant to which a Customer orders BPO Services from Provider.

  • Software Agreement means the agreements on the license and support of standard software.

  • Program Agreements means, collectively, this Agreement, the Guaranty, if any, the Custodial Agreement, the Pricing Side Letter, each Underlying Entity Agreement, if any, the Administration Agreement, the Electronic Tracking Agreement, if any, the Netting Agreement, the Custodial Account Control Agreement, each Holdback Account Control Agreement, if any, each Power of Attorney, each Servicing Agreement, if any, and each Servicer Notice, if any.

  • 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.

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

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

  • Seller Agreements means those agreements between Seller and third parties, including Artists and/or PRO, wherein Seller is entitled to receive the Percentage Interest of all Assets.

  • Managed Care Organization (MCO) means a contracted health delivery system providing capitated or prepaid health services, also known as a Prepaid Health Plan (PHP). An MCO is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law. An MCO may be a Chemical Dependency Organization (CDO), Dental Care Organization (DCO), Mental Health Organization (MHO), or Physician Care Organization (PCO).

  • Medicaid program means the medical assistance

  • End User Agreement means any agreement that Eligible Users are required to sign in order to participate in this Contract, including an end user agreement, customer agreement, memorandum of understanding, statement of work, lease agreement, service level agreement, or any other named separate agreement.