Non-Contract Provider definition

Non-Contract Provider means any person, organization, agency, or entity that is not directly or indirectly employed by a contractor or any of its subcontractors. Also see “Contractor” and “Provider.”

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Non-Contract Provider means an individual provider, clinic, group, association or facility that provides Covered Services and that does not have a provider agreement with the CONTRACTOR. Non-Medicaid Contractor means an entity contracting with a State Agency to provide medical and behavioral health services with the use of non-Medicaid funds. Non-participating Provider means a provider that is either actively enrolled with HSD, through an approved provider participation agreement, or that has been registered with HSD by the CONTRACTOR for providing services to its members but is not in the CONTRACTOR's network. Non-Preferred Drug means a non-covered drug, that may include both brand-name and generic drugs considered as non-formulary (also called a “Non-Preferred Drug”) and is not included on a Preferred Drug List (PDL). Non-Quantitative Treatment Limits (NQTLs) NQTLs are limitations on benefits or services that are not expressed numerically, but otherwise limit the scope or duration of benefits. Not Otherwise Medicaid Eligible refers to individuals not eligible for Medicaid services under New Mexico’s Medicaid State Plan.

Non-Contract Provider means an individual Provider, clinic, group, association, or facility that provides Covered Services and that does not have a provider agreement with the CONTRACTOR. Non-Medicaid Contractor means an entity contracting with a State Agency to provide medical and Behavioral Health services with the use of non-Medicaid funds. Non-Quantitative Treatment Limitations (NQTLs) are limitations on benefits or services that are not expressed numerically, but otherwise limit the scope or duration of benefits. Not Otherwise Medicaid Eligible refers to individuals not eligible for Medicaid services under New Mexico’s Medicaid State Plan. Nursing Facility (NF) means a licensed Medicare/Medicaid facility certified in accordance with 42 C.F.R. part 483 to provide inpatient room, board, and nursing services to Members who

Examples of Non-Contract Provider in a sentence

• This requirement applies whether or not the Non-Contract Provider is within the State.

• I/T/Us The CONTRACTOR shall reimburse both Contract and Non-Contract Provider I/T/Us at a minimum of one hundred percent (100%) of the rate currently established for the Indian Health Services (IHS) facilities or federally-leased facilities by the Office of Management and Budget (OMB).

• Non-Contract Providers for Women in the Third Trimester of Pregnancy If a pregnant woman in the third trimester of pregnancy has an established relationship with an obstetrical provider and desires to continue that relationship, and the Provider is not a Contract Provider, the CONTRACTOR shall reimburse the Non-Contract Provider in accordance with the applicable Medicaid fee schedule appropriate to the provider type.

• Any provider of Emergency Services that is a Non-Contract Provider must accept, as payment in full, no more than the amount established by HCA for such services.

• Non-Contract Provider – Any provider that is not directly or indirectly employed by or does not have a provider agreement with the CONTRACTOR or any of its subcontractors pursuant to the Agreement between the CONTRACTOR and TENNCARE.

• Tenant shall update the Non-Contract Provider List within thirty (30) days of learning that a provider is not contract with a payor on the Plan List.

• Any provider of Emergency Services that is a Non-Contract Provider must accept, as payment in full, no more than the amount established by HSD for such services.

• Non-Contract Provider – Providers that are licensed and/or certified by the appropriate South Carolina licensing body or standard-setting agency that have not contracted with or are not employed by the CONTRACTOR to provide health care services.

• For any Medical Services provided by a Non-Contract Provider that is not a hospital, 28 physician, or ambulance/paramedic service, CONTRACTOR shall reimburse said providers at rates 29 established for the MSI Program for the current Fiscal Year, or at other rates as may be directed, in 30 writing, by ADMINISTRATOR.

More Definitions of Non-Contract Provider

Non-Contract Provider means an individual provider, clinic, group, association or facility that provides Covered Services and that does not have a provider agreement with the CONTRACTOR. Non-Medicaid Contractor means an entity contracting with a State Agency to provide medical and behavioral health services with the use of non-Medicaid funds. Non-participating Provider means a provider that is either actively enrolled with HSD, through an approved provider participation agreement, or that has been registered with HSD by the

Non-Contract Provider means a provider that is not directly or indirectly employed by or does not have a provider agreement with the MCO or any of its subcontractors pursuant to the contract between the MCO and TennCare;

Non-Contract Provider means an individual Provider, clinic, group, association, or facility that provides Covered Services and that does not have a provider agreement with the CONTRACTOR. Non-Medicaid Contractor means an entity contracting with a State Agency to provide medical and Behavioral Health services with the use of non-Medicaid funds. Non-Quantitative Treatment Limitations (NQTLs) are limitations on benefits or services that are not expressed numerically, but otherwise limit the scope or duration of benefits. Not Otherwise Medicaid Eligible refers to individuals not eligible for Medicaid services under New Mexico’s Medicaid State Plan. Nursing Facility (NF) means a licensed Medicare/Medicaid facility certified in accordance with 42 C.F.R. part 483 to provide inpatient room, board, and nursing services to Members who require these services on a continuous basis, but who do not require hospital care or direct daily care from a physician. Nursing Facility Level of Care (NF LOC) means the Member's functional level is such that two (2) or more ADLs cannot be accomplished without consistent, ongoing, daily provision or assistance with prompting, of some or all of the following levels of service: skilled, intermediate or assisted. A Member must meet the NF LOC to be eligible for NF placement and community benefit services.

Non-Contract Provider means an individual provider, clinic, group, association or facility that provides Covered Services and that does not have a provider agreement with the CONTRACTOR. Non-Medicaid Contractor means the entity contracting with the Collaborative to provide Behavioral Health services with the use of non-Medicaid funds. Non-Preferred Drug means a non-covered drug, that may include both brand-name and generic drugs considered as non-formulary (also called a “Non-Preferred Drug”), and is not included on a PDL. Not Otherwise Medicaid Eligible refers to individuals not eligible for Medicaid services under New Mexico’s Medicaid State Plan. Nursing Facility (NF) means a licensed Medicare/Medicaid facility certified in accordance with 42 CFR Par t 483 to provide inpatient room, board and nursing services to Members who require these services on a continuous basis but who do not require hospital care or direct daily care from a physician. Nursing Facility Level of Care (NF LOC) means the Member's functional level is such that two or more activities of daily living cannot be accomplished without consistent, ongoing, daily provision, of some or all of the following levels of service: skilled, intermediate or assisted. A Member must meet the NF LOC to be eligible for nursing facility placement and communit y benefit services. Other Adult Group means t he cat ego r y o f Med ic a id e lig ib i l it y aut ho r ized in t he P at ie nt Prot ect io n a nd Affo r dable Car e Act t hat co ver s lo w - inco me par ent s and child le ▇▇ ▇▇▇ lt s bet ween 19 - 64 year s o f age w it h inco me up t o 133 per cent o f t he ▇▇▇▇▇ a l po ver t y le ve l as det er mined t hr o ugh t he Mo dified Ad ju s t ed Gro ss I nco me t est . Other Provider Preventable Conditions (OPPCs) means other provider preventable conditions that include the following three Medicare national coverage determinations: (i) wrong surgical or other invasive procedure performed on a patient; (ii) surgical or other invasive procedure performed on the wrong body part; and (iii) surgical or other invasive procedure performed on the wrong patient. Otherwise Medicaid Eligible refers to individuals who are eligible for Medicaid services under New Mexico’s Medicaid State Plan. Overpayment means any funds that a person or entity receives in excess of the Medicaid allowable amount or the CONTRACTOR's allowed amount as negotiated with the Contract Provider, or to which the Contract Provider is not entitled under Title XIX of ...