Medicare Administrative Contractor definition

Medicare Administrative Contractor means a contractor designated by the Centers for Medicare and Medicaid Services for the administration of the Medicare program in each applicable jurisdiction.
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Medicare Administrative Contractor means a private healthcare insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service beneficiaries.
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Medicare Administrative Contractor has the meaning set forth in Section 911(a) of the Medicare Prescription Drug Improvement, and Modernization Act of 2003, as amended.
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Examples of Medicare Administrative Contractor in a sentence

  • Under this Settlement Agreement, Class Members will receive, only as set forth in this paragraph, Review of Eligible Claims either: (a) by Medicare Administrative Contractor (MAC), National Government Services (NGS) for cases not currently pending in the Medicare administrative claims appeals process, or (b) by the Medicare appeals adjudicator with jurisdiction over the pending appeal containing the Eligible Claim, for cases currently pending in the Medicare administrative claims appeals process.

  • In cases where the Enrollee may have enrolled or disenrolled from the STAR+PLUS MMP during the billing period, the SNF will split the bill and send the STAR+PLUS MMP’s portion to it and the remaining portion to the new Medicare Advantage plan or Medicare Administrative Contractor for Original Medicare.

  • The Medicare Allowable Payment (Outpatient Services) is subject to Company’s payment and processing guidelines and is final and will not be impacted by cost settlements, reconciliations, or any other retroactive adjustments performed by a Medicare Administrative Contractor (MAC) for both overpayments and underpayments.

  • These payments are intended to mirror the payment a Medicare Administrative Contractor (MAC) would make to the hospital, less (with respect to DRG-based payments) the payments for Operating Indirect Medical Education (IME), Direct Graduate Medical Education (DGME) and adjustments due to Company payment and processing guidelines.

  • OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from the Provider to the appropriate Federal health care program payor, including the Medicare contractor (e.g., Medicare Administrative Contractor), for appropriate follow-up by that payor.

  • Inquiries can be directed to Customer’s respective Medicare Administrative Contractor or to appropriate payers.

  • The Medicare Administrative Contractor (MAC) must make a determination within 60 days of receiving your request.

  • Under what is sometimes called “traditional Medicare,” “Medicare fee-for-service,” or “Medicare Part B,” health care providers such as Lincare directly bill Medicare for each covered item or service by submitting claims to Medicare through a Medicare Administrative Contractor (MAC).

  • OIG, in its sole discretion, may refer the findings of the Full Sample (and any related workpapers) received from OFX to the appropriate Federal health care program payor, including the Medicare contractor (e.g., carrier, fiscal intermediary, or Durable Medical Equipment Medicare Administrative Contractor, as applicable), for appropriate follow-up by that payor.

  • Upon execution of this Agreement by both parties, the City agrees to immediately complete a “Medicare Enrollment Application” stating that the City and NVAD voluntarily terminate its Medicare enrollment as a ground ambulance service supplier, effective immediately, and submit the application to the appropriate Medicare Administrative Contractor.

Related to Medicare Administrative Contractor

  • Emergency medical services provider means a person who has received formal training in prehospital and emergency care, and is licensed to attend any person who is ill or injured or who has a disability. Police officers, firefighters, funeral home employees and other persons serving in a dual capacity one of which meets the definition of “emergency medical services provider” are “emergency medical services providers” within the meaning of this chapter.

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.

  • 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.

  • 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.

  • Specialty contractor means a person who is licensed to conduct business as described in subsection 4 of NRS 624.215.

  • Dependent care assistance program means a benefit plan

  • Emergency medical services personnel means that term as defined in section 20904 of the public health code, 1978 PA 368, MCL 333.20904.

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Non-Administrator Dialysis Facility means a Dialysis Facility which does not have an agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan but has been certified in accordance with the guidelines established by Medicare.

  • 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.

  • Primary care provider (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.

  • Primary care physician means a physician who is a family

  • Mental health services provider means an individual, licensed or unlicensed, who performs or purports to perform mental health services, including a:

  • 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.

  • Medical provider means a medical service provider, a hospital, a medical clinic, or a vendor of medical services.

  • Medicare Advantage The Medicare managed care options that are authorized under Title XVIII as specified at Part C and 42 C.F.R. § 422.

  • HMO means health maintenance organization.

  • 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.

  • PJM Administrative Service means the services provided by PJM pursuant to Tariff, Schedule 9. PJM Board:

  • primary carer means the person who has responsibility for the care of the Child. Only one person can be the Child’s Primary Carer on a particular day.

  • Direct care worker means a paid caregiver who provides direct, hands-on personal care services to persons with disabilities or the elderly requiring long-term care.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Contractor Personnel means Contractor’s employees and subcontractors (as well as any employees or subcontractors of those subcontractors) performing the Services.

  • Provider is any individual or company that provides professional or technical services.