Managed Care Network definition

Managed Care Network means a network of “ Participating Providers” that is, physicians hospitals, other healthcare providers that participate in a network established and maintained by the Contractor, having entered into agreements with the Contractor to provide healthcare services to plan participants for a negotiated reimbursement rate. A healthcare provider that does not participate in the Contractor’s established network but enters into a limited “case rate” agreement shall be considered a non-Network or non-participating provider.
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Managed Care Network means the Network of health care providers that have entered into contracts with Anthem and/or one or more of its Affiliates pursuant to which those providers have agreed to participate in the Anthem programs that are to be provided pursuant to the Health Benefit Plan.
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Managed Care Network means the network of health care providers that have entered into contracts with BLUE CROSS and/or one or more of its Affiliates pursuant to which those providers have agreed to participate in BLUE CROSS SENIOR SECURE and other programs that are to be conducted pursuant to Benefit Agreements.
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Examples of Managed Care Network in a sentence

  • The Forensic Mental Health Services Managed Care Network (Forensic Network) is hosted by The State Hospital, and good partnership working is in place across the Forensic Network to ensure patients are transferred as required.

  • In addition, Blue Shield may extend this Agreement to managed care arrangements established by Blue Shield subsidiaries, or by persons or entities utilizing the Managed Care Network which Blue Shield has established pursuant to agreements with CareTrust Networks and Blue Shield of California Life & Health Insurance Company.

  • Additionally, per the Federal Managed Care Network Adequacy Final Rule requirements, 100% of direct service practitioners (psychotherapists, psychiatrists, case managers, etc.) must complete cultural competence training within the past 12 months to meet annual reporting requirements.

  • When the BLUE CROSS Managed Care Network is utilized by an Affiliate or Other Payor, PARTICIPATING MEDICAL GROUP agrees to provide services to Covered Persons of that Affiliate or Other Payor in accordance with the terms of this Agreement.

  • When an Other Payor utilizes the Managed Care Network, such Other Payor shall comply with the terms of this Agreement.

  • In the event the BLUE CROSS Managed Care Network is to be utilized by an Other Payor that has operational requirements that are materially different from those required under this Agreement, BLUE CROSS agrees to notify PARTICIPATING MEDICAL GROUP in writing thirty (30) days prior to the commencement of such utilization.

  • The BBV Managed Care Network (MCN) is the local structure that has been established to support a multi-agency, collaborative approach, encouraging participation of all partners, including people living with BBVs. NHS Ayrshire & Arran, Public Health Department leads a multi-agency and multi- disciplinary team (MDT), which is responsible for delivery of the Sexual Health & BBV Outcomes Framework.

  • To provide employees, retirees, and dependents with a comprehensive, quality health program.Outcome (Results/Impact):Percent of Managed Care Network Participants Rating ERSInsurance Services as Satisfactory or Better85%85%B.1.1. Strategy: GROUP INSURANCEProvide a basic health care and life insurance program for general state employees, retirees, and their dependents.

  • Requests to take discovery must be made in writing to the Hearing Officer with notice to the other party.

  • The Company has explained to me the Managed Care procedures, and employee understands and agrees to use these medical providers exclusively and otherwise comply with the Managed Care Network rules.


More Definitions of Managed Care Network

Managed Care Network. Group of Network Providers who have entered into or are governed by contractual arrangements under which they agree to provide health care services to Participants and accept negotiated fees for these services. Network Pharmacy: Pharmacy which has entered into an agreement with us or our affiliate or subcontractor to provide prescription drug services to Participants. Network Provider: Health care provider who participates in one of our Managed Care Networks. Overpayments: Payments that exceed the amount payable under the Plan (for example, because of a provider billing error, retroactive or inaccurate eligibility information, coordination of benefits, Medicare disputes, or missing information), and other overcharges made by providers, including hospitals discovered during the course of a hospital xxxx audit. Participant: Subscriber or dependent who is covered by the Plan. Plan: The Plan to which this Agreement applies, but only with respect to those provisions of the Plan relating to the self-funded health benefits we are administering, as described in the Description of Benefits.
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Related to Managed Care Network

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • 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: achieving high-quality outcomes for participants, coordinating access, and containing costs.

  • 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.

  • 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).

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

  • 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 network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • 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).

  • 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.

  • Network pharmacy means any pharmacy that has an agreement to accept our pharmacy allowance for prescription drugs and diabetic equipment/supplies covered under this agreement. All other pharmacies are NON-NETWORK PHARMACIES. The one exception and for the purpose of specialty Prescription Drugs, only specialty pharmacies that have an agreement to accept our pharmacy allowance are network pharmacies and all others pharmacies are non-network pharmacies.

  • HMO a health maintenance organization doing business as such (or required to qualify or to be licensed as such) under HMO Regulations.

  • BT Network means the communications network owned or leased by BT and used to provide a Service.

  • 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.

  • system user means a natural or legal person supplying to, or being supplied by, a transmission or distribution system;

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

  • Child care facility or “facility” means a child care center, a preschool, or a registered child development home.

  • Direct care worker means a paid individual who provides direct, personal care services to persons with disabilities or the elderly requiring long-term care (see also the definition of long-term care worker, which includes direct care workers).

  • Secure Network means a network which is only accessible by Secure

  • Customer Proprietary Network Information (“CPNI”) is as defined in the Act.

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).

  • Mobile Network means a 3G or 4G network or any other mobile communications network which we choose to provide Mobile services.

  • Child care services means the range of activities and programs provided by a certificate holder to an enrolled child, including personal care, supervision, education, guidance, and transportation.

  • Database Management System (“DBMS”) is a computer process used to store, sort, manipulate and update the data required to provide Selective Routing and ALI.

  • Open Wireless Network means any network or segment of a network that is not designated by the State of New Hampshire’s Department of Information Technology or delegate as a protected network (designed, tested, and approved, by means of the State, to transmit) will be considered an open network and not adequately secure for the transmission of unencrypted PI, PFI, PHI or confidential DHHS data.

  • Residential child care facility means a twenty-four-hour residential facility where children live together with or are supervised by adults who are not their parents or relatives;

  • Core Network means the transport infrastructure identified in accordance with Chapter III of Regulation (EU) No 1315/2013;