Medicare Advantage Member definition

Medicare Advantage Member means a Member who is enrolled in and covered under a Medicare Advantage Program.
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Medicare Advantage Member or “Medicare Advantage Subscriber” means an individual who is enrolled in and covered under a Medicare Advantage Program or any successor program(s) thereto regardless of the name(s) thereof. Dually eligible Medicare Advantage Subscribers are those individuals who are (i) eligible for Medicaid; and (ii) for whom the state is responsible for paying Medicare Part A and B cost sharing.
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Medicare Advantage Member. MA Member")" means, for purposes of this Attachment, a Member who is covered under a Medicare agreement between CMS and Plan under Part C of Title XVIII of the Social Security Act ("Medicare Advantage Program") and for Plan's DSNP Medicare Program, the beneficiary is also entitled to Medicaid under Title XIX of the Social Security Act, see 42 USC §1396 et seq..
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Examples of Medicare Advantage Member in a sentence

  • The Medicare Advantage Member may also initiate a coverage determination by calling the customer service number on the back of the Member ID card.Insulin self-administered without a pump:Medicare Advantage Members who do not use a pump to administer their insulin do not need to a request a coverage determination.

  • For assistance with claims, billing, or membership card questions, please call or write to Kaiser Permanente Medicare Advantage Member Services.

  • Blue Medicare Advantage Member Responsibility and LiabilityThe member or representative is responsible for acknowledging receipt of the NOMNC by signing the document.

  • Without limiting the generality of the foregoing, in the event the Member is a Medicare Advantage Member and submits an appeal to Company, Company shall, upon request of Provider, furnish Provider with copies of the Medicare Advantage Member’s appeal.

  • When applicable, Provider agrees to comply with Company’s procedures for Medicare Advantage Member grievances, organization determinations and Medicare Advantage Member appeals as required by the Medicare Advantage Program.

  • This Agreement does not prohibit Dentist from collecting Arkansas Blue Medicare and Health Advantage Medicare Advantage Member Cost Sharing, as specifically provided in the Plan Description, or fees for non-covered services as long as Arkansas Blue Medicare and Health Advantage Medicare Advantage Member has been informed in advance that services are not covered and that Arkansas Blue Medicare and Health Advantage Medicare Advantage Member is financially responsible for any non-covered services.

  • The Medicare Advantage Member may also initiate a coverage determination by calling the customer service number on the back of the Member ID card.

  • When submitting an insulin Claim for a Medicare Advantage Member, you will receive the following message: “Part B if pump, call 1-800-711-4555.” To ensure Claims are paid under the correct benefit, please notify the Prescriber and Medicare Advantage Member the review is required to determine coverage when insulin is administered in a pump.

  • Dentist agrees that in no event, including, but not limited to non-payment by PPP Arkansas, insolvency of PPP Arkansas, or breach of the Agreement shall Dentist bill, charge, collect a deposit from, impose surcharges or have any recourse against an Arkansas Blue Medicare and Health Advantage Medicare Advantage Member or a person acting on behalf of an Arkansas Blue Medicare and Health Advantage Medicare Advantage Member for Covered Services provided pursuant to this Agreement.

  • Regence offers the following Member Contracts for its Medicare Advantage Members to choose from during the open enrollment period.• Medicare Advantage HMO• Medicare Advantage PPO These Medicare Advantage Member Contracts cover a limited number of dental services.


More Definitions of Medicare Advantage Member

Medicare Advantage Member means a Member who is enrolled in or who has entered into contract with or on whose behalf a contract has been entered into with Plan(s), for the provision of Covered Services under a Medicare Advantage Program.
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Medicare Advantage Member means a Member who is enrolled in and who is covered under a Medicare Advantage Program.
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Medicare Advantage Member or “MA Member” - A MA eligible individual who has enrolled in or elected coverage through a Plan, a MA Organization. “Provider” - (1) Any individual who is engaged in the delivery of health care services in a state and is licensed or certified by the state to engage in that activity in the state; and (2) any entity that is engaged in the delivery of health care services in a state and is licensed or certified to deliver those services if such licensing or certification is required by state law or regulation.
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Related to Medicare Advantage Member

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Health care entity means any health care provider, health plan or health care clearinghouse.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • 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.

  • Licensed health care practitioner means a physician, as defined in Section 1861(r)(1) of the Social Security Act, a registered professional nurse, licensed social worker or other individual who meets requirements prescribed by the Secretary of the Treasury.

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

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

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

  • 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).

  • Health care practitioner means an individual licensed

  • Health care facility or "facility" means hospices licensed

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • 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.

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Rehabilitation Hospital means an Institution which mainly provides therapeutic and restorative services to Sick or Injured people. It is recognized as such if:

  • Health practitioner means a registered health practitioner registered or licensed as a health practitioner under an appropriate law of the State of Tasmania.

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Non-Participating Orthotic Provider means an Orthotic Provider who 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.

  • Dental practitioner means a person in private practice registered by the Australian Dental Association.

  • 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.

  • Affordable Care Act means the Patient Protection and Affordable Care Act of 2010 (Pub. L. 111–148), as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. 111–152).

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • 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.

  • Dependent care assistance program or "DCAP" means a benefit plan whereby school employees may pay for certain employment related dependent care with pretax dollars as provided in the salary reduction plan under chapter 41.05 RCW pursuant to 26 U.S.C. Sec. 129 or other sections of the Internal Revenue Code.

  • Non-Participating Certified Nurse Practitioner means a Certified Nurse Practitioner who 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.

  • Individualized Education Program (IEP means a written statement for a child with a disability that is developed, reviewed, and revised in accordance with Sections 300.320 through 300.324 of 34 CFR.