Participant Provider definition

Participant Provider means an individual or entity that satisfies the requirements of Section 4.01.A.
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Participant Provider means an individual or entity that: (1) is a Medicare- enrolled provider or supplier (as described in 42 C.F.R. § 400.202); (2) is identified on the DCE’s list of Participant Providers by name, individual National Provider Identifier (“NPI”), tax identification number (“TIN”), Legacy TIN or CMS Certification Number (“CCN”) (if applicable); (3) bills for items and services it furnishes to Medicare FFS beneficiaries under a Medicare billing number assigned to a TIN in accordance with applicable Medicare regulations; (4) is not a Preferred Provider nor a Prohibited Participant (as defined below); and (5) has agreed to participate in the Direct Contracting Model pursuant to a written agreement with the DCE.
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Participant Provider means a provider who has entered into a service agreement with a service corporation;
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Examples of Participant Provider in a sentence

  • If the Plan must bring an action against a Plan Participant, Provider or other person or entity to enforce the provisions of this section, then that Plan Participant, Provider or other person or entity agrees to pay the Plan’s attorneys’ fees and costs, regardless of the action’s outcome.

  • The arrangement requires the Participant Provider or Preferred Provider to complete a close-out process upon termination or expiration of the arrangement that requires the Participant Provider or Preferred Provider to furnish all data required by the ACO to participate in the Model and any data required by CMS to monitor or evaluate the Model.

  • The ACO shall update the Participant Provider List and Preferred Provider List to reflect the relevant changes in Medicare enrollment information for individuals and entities identified on such lists.

  • For each Performance Year that the ACO selects to participate in the APO, the arrangement prohibits a Participant Provider that is added to the Participant Provider List during the Performance Year or a Preferred Provider that is added to the Preferred Provider List during a Performance Year from participating in the APO for the Performance Year in which the Participant Provider or the Preferred Provider is so added.

  • If the ACO selects to provide a Benefit Enhancement for a Performance Year, the ACO’s Participant Providers and Preferred Providers, as indicated on the relevant Participant Provider List and Preferred Provider List under Article IV, may submit claims for services furnished pursuant to such Benefit Enhancement as described in this Article X during the Performance Year for which the ACO selected to provide the Benefit Enhancement.

  • For purposes of furnishing Benefit Enhancements and participating in the ACO’s selected Capitation Payment Mechanism, the removal of an individual or entity from the Participant Provider List or Preferred Provider List will be effective on the last day of the month the individual or entity ceases to meet the requirements of Section 4.01.A(1)-(5) or Section 4.01.B(1)-(5), as applicable.

  • By a date specified by CMS, the ACO shall furnish written notification to each individual or entity the ACO wishes to include on the Proposed Revised Participant Provider List.

  • The arrangement requires the Participant Provider or Preferred Provider to agree to participate in the Model during the Agreement Performance Period, to engage in ACO Activities, to comply with the applicable terms of the Model as set forth in the Agreement, and to comply with all applicable laws and regulations (including, but not limited to, those specified at Section 15.04).

  • On February 16, 2021, CLF filed a citizen suit under § 505 of the CWA against Barnstable.

  • Consistent with Section 1802(a) of the Act, neither the ACO nor any Participant Provider, Preferred Provider, or other individuals or entities performing functions or services related to ACO Activities or Marketing Activities, shall commit any act or omission, nor adopt any policy, that inhibits Beneficiaries from exercising their freedom to obtain health services from providers and suppliers who are not Participant Providers or Preferred Providers.

Related to Participant Provider

  • Participant ID means each unique identifier assigned to a Participant other than a DMA Customer by BSEF for access to the SEF operated by BSEF.

  • Participant has the meaning specified in Section 10.06(d).

  • Participant Group means you, each of your holding companies and subsidiaries and each subsidiary of each of your holding companies (as each such term is defined in the Companies Act 1985); and

  • FTR Participant means any Market Participant that provides or is required to provide Collateral in order to participate in PJM’s FTR auctions.

  • Designated Participant means such employees or officers of the Company or a related entity of the Company as the Board may designate from time to time as eligible to participate in the Plan;

  • CDS Participant means a participant in CDS that holds security entitlements in Units on behalf of beneficial owners of those Units;

  • Program participant means an individual certified by the secretary as a program participant under Iowa Code section 9E.3.

  • Participant contract means a contract by which a sponsored captive insurance company insures the risks of a participant and limits the losses of the participant to the assets of a protected cell.

  • Other Participant means a cooperative project participant other than the United States.

  • First Tier Participant refers to the participant who has entered into a covered transaction with a grantee or subgrantee of Federal funds (such as the prime or general contractor). “Lower Tier Participant” refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers).

  • L/C Participant shall have the meaning provided in Section 3.3(a).

  • Loan Participant means each Purchaser and its respective successors and registered assigns, including any Certificate Holder.

  • Covered Participant means a Participant who is a “covered employee” as defined in Section 162(m)(3) of the Code, and the regulations promulgated thereunder, and any individual the Committee determines should be treated as such a covered employee.

  • Retired Participant means a person who has been a Participant, but who has become entitled to retirement benefits under the Plan.

  • Key participant means a sole proprietor, a partner in partnership, or a person with executive managerial control in a corporation. A person with executive managerial control includes persons such as a chief executive officer, chief operating officer and chief financial officer. This definition does not include non-executive managers such as farm, field, or shift managers.

  • Lower Tier Participant refers any participant who has entered into a covered transaction with a First Tier Participant or other Lower Tier Participants (such as subcontractors and suppliers).

  • Participants is defined in Section 12.2.1.

  • Terminated Participant means a person who has been a Participant, but whose employment has been terminated other than by death, Total and Permanent Disability or retirement.

  • Non-U.S. Participant means any Participant that if it were a Lender would qualify as a Non-U.S. Lender.

  • Non-Participating Provider means an Administrator Hospital or Professional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Participating Provider.

  • A Participant or beneficiary ("claimant") who has not received benefits under the Plan that he or she believes should be paid shall make a claim for such benefits as follows:

  • Authorised Participant Agreement means, in respect of an Authorised Participant, the authorised participant agreement (as amended, supplemented, novated and/or replaced from time to time) entered into by the Issuer and such Authorised Participant.

  • Auction Participant or “Bidder” means a Person or Persons who submitted a bid as per the E- Auction Process Memorandum; and shall include a Qualified Bidder or the Successful Bidder and as the context requires;

  • U.S. Participant means a Participant who is a citizen of the United States or a resident of the United States, as defined in section 7701(a)(30)(A) and section 7701(b)(1) of the Code and any other Participant who is subject to tax under the Code with respect to compensatory awards granted pursuant to the Plan;

  • Participating Provider means an Administrator Hospital or Professional Provider which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or an Administrator facility which has been designated by the Claim Administrator as a Participating Provider.

  • Voting Participant has the meaning specified in Section 10.06(d).