Other Payors definition

Other Payors means persons or entities, utilizing the Network(s)/Plan Program(s) pursuant to an agreement with Anthem or an Affiliate, including without limitation, other Blue Cross and/or Blue Shield Plans that are not Affiliates, and employers or insurers providing Health Benefit Plans pursuant to insured, self-administered or self-insured programs.
Sample 1Sample 2Sample 3
Other Payors are employers, insurance companies, associations, health and 27 welfare trusts, and other organizations with which Blue Shield contracts to provide 1 administrative services for plans provided by those entities that are not underwritten 2 by Blue Shield (including both local and Blue Cross/Blue Shield National Accounts 3 Programs), as well as other entities to which Blue Shield has extended this 4 Agreement pursuant to managed care arrangements established by Blue Shield 5 subsidiaries, or by persons or entities using the network Blue Shield has established 6 pursuant to agreements with CareTrust Networks and Blue Shield of California Life 7 & Health Insurance Company.” BSA § 2.18 (2008 amendment) (emphasis added).
Sample 1

Examples of Other Payors in a sentence

  • The identity of Other Payors shall be disclosed in the Provider Manual.

  • Blue Shield shall require that: (a) the health programs of Other Payors include provisions to encourage the use of Blue Shield contracting providers, and (b) Other Payors comply with performance standards relating to timely processing of claims which meet or exceed the time requirements set forth in California law.

  • Other Payors The Hospital also has entered into payment agreements with certain commercial insurance carriers and preferred provider organizations.

  • Other Payors Hendricks also has entered into payment agreements with certain commercial insurance carriers and preferred provider organizations.

  • Other Payors MHP also has entered into payment agreements with certain commercial insurance carriers and preferred provider organizations.

  • Physician Allowances for Other Payors Physician reimbursements for payors other than Healthgram may vary.

  • NOTES TO CONSOLIDATED FINANCIAL STATEMENTS DECEMBER 31, 2012 Other Payors The Hospital also has entered into payment agreements with certain commercial insurance carriers and preferred provider organizations.

  • BLUE CROSS will disclose upon initial signing of this Agreement and within 30 days of receipt of a written request from PARTICIPATING MEDICAL GROUP a summary of all Other Payors and Affiliates currently eligible to pay the negotiated rates under this Agreement as a result of their arrangement with BLUE CROSS.

  • You can obtain the Other Payors list on the Availity web portal, at www.Availity.com.

  • Physician Allowances for Other Payors Physician reimbursements for payors other than Primary PhysicianCare may vary.

Related to Other Payors

  • Payors shall have the meaning set forth in Section 3.27.

  • Third Party Payors means Medicare, Medicaid, CHAMPUS, Blue Cross and/or Blue Shield, private insurers and any other Person which presently or in the future maintains Third Party Payor Programs.

  • 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.

  • Third Party Payor means Medicare, Medicaid, TRICARE, and other state or federal health care program, Blue Cross and/or Blue Shield, private insurers, managed care plans and any other Person or entity which presently or in the future maintains Third Party Payor Programs.

  • Third Party Payor Programs means all third party payor programs in which Tenant presently or in the future may participate, including, without limitation, Medicare, Medicaid, CHAMPUS, Blue Cross and/or Blue Shield, Managed Care Plans, other private insurance programs and employee assistance programs.

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

  • Medicare Provider Agreement means an agreement entered into between CMS or other such entity administering the Medicare program on behalf of CMS, and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • TRICARE means, collectively, a program of medical benefits covering former and active members of the uniformed services and certain of their dependents, financed and administered by the United States Departments of Defense, Health and Human Services and Transportation, and all laws applicable to such programs.

  • 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.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

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

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Health care facility or "facility" means hospices licensed

  • 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.

  • Third Party Payments means the payment made through instruments issued from an account other than that of the beneficiary investor mentioned in the application form. However, in case of payments from a joint bank account, the first named applicant/investor has to be one of the joint holders of the bank account from which payment is made.

  • 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:

  • Capitation means the reimbursement arrangement in which a fixed rate of payment per Enrollee per month is made to the Contractor for the performance of all of the Contractor’s duties and obligations pursuant to this Contract.

  • Medical care facility as used in this title, means any institution, place, building or agency, whether

  • Provider fee means the consideration paid for a service contract.

  • Third-party payer means an entity that is, by

  • Payor means a trustee, insurer, business entity, employer, government, governmental subdivision or agency, or other person authorized or obligated by law or a governing instrument to make payments.

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

  • Bank Product Provider Agreement means an agreement in substantially the form attached hereto as Exhibit B-2 to this Agreement, in form and substance satisfactory to Agent, duly executed by the applicable Bank Product Provider, the applicable Loan Parties, and Agent.

  • Medicaid program means the Kansas program of medical

  • Medicare eligible expenses means expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.