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.

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

  • Except for specific areas inapplicable in a specific participant provider service agreement, at a minimum, a participant provider service agreement shall include, but is not limited to, the following requirements: Participant Provider Service Agreement The participant and provider entering into the agreement are clearly defined.

  • By providing this Agreement to Participant and making the Program available through Participant, Provider and Bank agree to be bound by this Agreement.

  • Participant, Provider and Bank are each independent parties to this Agreement, and this Agreement shall not establish a joint venture, partnership, agency or employment relationship between any party and any other party for any purpose whatsoever.

  • 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.

  • By a date specified by CMS, the ACO shall furnish written notification to the executive of any TIN through which an individual or entity on the Proposed Revised Participant Provider List or Proposed Revised Preferred Provider List bills Medicare.

  • CMS shall conduct a Program Integrity Screening for each individual and entity on the Proposed Revised Participant Provider List and the Proposed Revised Preferred Provider List.

  • If You believe legal services are necessary or would be helpful to resolve Your dispute with a Health and Wellness Participant (Provider), CamCare encourages You to consult with an attorney.

  • Subject to the terms and conditions set forth in this Agreement and relying on the representations, warranties and covenants contained herein, Participant, Provider and Bank will provide the services described in this Agreement to facilitate the delivery of federal and/or state income tax refunds to Customers of the Participant.

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 a key Employee of the Company or any other Participating Company who is designated by the Committee in writing to participate in the Program.

  • 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.

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

  • 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.

  • 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).

  • L/C Participants the collective reference to all the Revolving Lenders other than the Issuing Lender.

  • Participating employee means an employee whose election to participate in a Plan has been approved by the employer.

  • Inactive Participant means each Participant (other than a Retired Participant, Deceased Participant or Disabled Participant) who is not in active service as an Outside Director and is not actively employed by a Participating Company.