Participating Payer definition

Participating Payer or “Payer” means a public or private insurer, health service corporation, or health maintenance organization that has entered into an agreement with MDHHS to participate in PCMH Initiative.
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Participating Payer means a corporation, partnership, labor union, association, program, employer or any other entity responsible for the payment of Covered Services rendered to a Covered Member through a Participating Plan.
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Participating Payer means a Payer which is either contracted directly with the Provider or has elected to subsidize a portion of the costs associated with translating, editing, processing and reporting of electronic Claims and other transactions on behalf of its contracted Providers. “Party or Parties” means, individually, a party to the Agreement, and, collectively, the parties to the Agreement, as set forth on the Purchase Order.
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Examples of Participating Payer in a sentence

  • If within thirty (30) days following CHCís notice to Vendor of its excessive rejected Transaction rate, such Transaction rate is not brought to three percent (3%) or less, CHC shall have the right to charge Vendor thereafter a standard Per Transaction Fee for each rejected CHC Non-Participating Payer Transaction and twenty-five cents ($0.25) for each rejected CHC Participating Payer Transaction of Vendorís Customers in excess of three percent (3%) for any month.

  • In this regard, Vendor shall not (i) submit any Transactions to CHC Participating Payers (whether directly or indirectly through a CHC Competitor or other person or entity) other than through the CHC Services or (ii) market or contract for, or take any steps to effect (including without limitation the establishment of connections or interfaces for), the direct or indirect submission of Transactions to or with any entity, which is, or is capable of becoming, a CHC Participating Payer.

  • If within thirty (30) days following CHC’s notice to Vendor of its excessive rejected Transaction rate, such Transaction rate is not brought to three percent (3%) or less, CHC shall have the right to charge Vendor thereafter a standard Per Transaction Fee for each rejected CHC Non- Participating Payer Transaction and twenty-five cents ($0.25) for each rejected CHC Participating Payer Transaction of Vendor’s Customers in excess of three percent (3%) for any month.

  • While the Centers for Medicare and Medicaid Services (CMS) is not a Participating Payer, Participating ACOs are contractually obligated to submit Medicare Shared Savings Program (MSSP) quality measures to the GMCB.


More Definitions of Participating Payer

Participating Payer means a payer that operates in rural counties and signs an agreement with the authority to participate in the global budget model;
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Related to Participating Payer

  • Participating Party means an enterprise or public body that has committed itself to reaching certain objectives under a voluntary agreement, or is covered by a national regulatory policy instrument;

  • Participating Country’ means any country that the Association determines meets the requirements set forth in Section 11 of Resolution No. 194 of the Board of Governors of the Association, adopted on April 8, 1999; and ‘Participating Countries’ means, collectively, all such countries."; and (b) The second sentence of Section 5.01 is modified to read: "Except as the Borrower and the Association shall otherwise agree, no withdrawals shall be made: (a) on account of expenditures in the territories of any country which is not a Participating Country or for goods produced in, or services supplied from, such territories; or (b) for the purpose of any payment to persons or entities, or for any import of goods, if such payment or import, to the knowledge of the Association, is prohibited by a decision of the United Nations Security Council taken under Chapter VII of the Charter of the United Nations." Section 1.02. Unless the context otherwise requires, the several terms defined in the General Conditions and in the Preamble to this Agreement have the respective meanings therein set forth and the following additional terms have the following meanings:

  • Participating Dentist means any Dentist who, at the time of rendering a Covered Dental Service to the Member, has a written agreement with CareFirst BlueChoice or the Dental Plan for the rendering of such service.

  • 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.

  • 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.

  • Participating physician means a physician licensed in Virginia to practice medicine, who practices

  • Participating student means a student who has been determined to be

  • Participating Share or “Share” means the Participating Shares of no par value in the

  • 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.

  • Participating Pharmacy means a pharmacy that has entered into a prescription drug plan agreement with the Pharmacy Benefit Manager listed on your identification card.

  • Participating county means a county that has been authorized by the county governing body to enter into a contract with another local unit pursuant to section 4.

  • 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.

  • Participating Bank means any participating banks of the JETCO ATM network, (if applicable) PLUS ATM network and/or (if applicable) China UnionPay ATM network;

  • Participating Account a separate account investing all or a portion of its assets in the Trust, including the Account.

  • Participating Hospital means an Administrator Hospital that has an agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide Hospital services to participants in the Participating Provider Option program.

  • Participating Broker- Dealer: See Section 2(b) hereof. Person: An individual, trustee, corporation, partnership, limited liability company, joint stock company, trust, unincorporated association, union, business association, firm or other legal entity. Private Exchange: See Section 2(b) hereof.

  • Participating Addendum means a bilateral agreement executed by a Contractor and a Participating Entity incorporating this Master Agreement and any additional Participating Entity-specific language or other requirements (e.g., ordering procedures specific to the Participating Entity, entity-specific terms and conditions, etc.).

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

  • Participating Interest is defined in Section 1.2(d) hereof.

  • Participating Prosthetic Provider means a Prosthetic 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.

  • Participating Countries means, collectively, all such countries.”

  • Participating public employer means a public employer as defined in ORS 238.005 that

  • Non-Participating Hospital means an Administrator Hospital that does not meet the definition of a Participating Hospital.

  • Participating Entity means a state (as well as the District of Columbia and US territories), city, county, district, other political subdivision of a State, or a nonprofit organization under the laws of some states properly authorized to enter into a Participating Addendum, that has executed a Participating Addendum.

  • Non-Participating Prosthetic Provider means a Prosthetic 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.

  • Participating institution means an "institution" as defined in KRS 164.001 that actively participates in the federal Pell Grant program, executes a contract with the authority on terms the authority deems necessary or appropriate for the administration of its programs, and: