Participating Payor definition

Participating Payor. – means a payor that is participating in the Program either on its own behalf or through an authorized agent that is a participant.
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Participating Payor means any organization that has a contractual obligation to provide Covered Services to Members and/or Member Groups, whereby Members and/or Member Groups are provided with incentives to obtain services from CHPC/CSI and/or Participating Practitioners.
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Examples of Participating Payor in a sentence

  • If Practitioner’s specialty has been so designated, the Practitioner agrees to be a CHPC/CSI treating doctor and agrees to comply with all requirements that the Acts impose upon treating doctors in the Participating Payor guidelines, rules and procedures, as well as any additional responsibilities that CHPC/CSI may from time to time request.

  • CHPC/CSI, Participating Payor or any insurance carrier customer shall provide written notice to Practitioner before the carrier, Participating Payor or CHPC/CSI conducts economic profiling, including utilization management studies comparing the Practitioner to other Practitioners, or other profiling of the Practitioner.

  • Participating Practitioner agrees that CSI/CHPC is only able to inform Participating Payor of Participating Practitioner=s specification of Categories of Coverage and other pertinent information as supplied by Participating Practitioner and therefore, CSI/CHPC is not responsible for any failure of or by Participating Payor and/or Participating Practitioner to correctly utilize such information.

  • Participating Payor shall furnish to Practitioner, and Practitioner shall abide by, the list of any treatments and services that require Participating Payor’s preauthorization and any procedures the Practitioner must follow in order to obtain preauthorization.

  • Any nursing facility located in the State that meets both of the following criteria would be eligible to join Requestor’s Network: (1) the nursing facility maintains an overall quality rating of 3-stars or higher on the Centers for Medicare & Medicaid Services (“CMS”) Nursing Home Compare website;1,2 and (2) the nursing facility agrees to provide a discount of up to [amount redacted] off its daily private payor rate for a semi- private room (the “Discount”) covered by a Participating Payor.

  • The availability of the Discount on the days of stay covered by the Participating Payor does not increase the already-present likelihood that a Beneficiary may choose to receive the items or services from the nursing facility in which he or she resides, e.g., for reasons of convenience and known quality of care.

  • Participating Practitioner shall not bill for or collect from Member, payment for co- insurance, deductibles or Non-Covered Services prior to receipt of an explanation of benefits (EOB) from Participating Payor or its designee.

  • Vendor shall give NEIC 90 days from the date of Vendor's notice to effect a contract with such entity to become an NEIC Participating Payor before Vendor markets to or contracts with such entity for direct transmission of electronic transactions.

  • We recognize that a Beneficiary may select a Network Nursing Facility for stays covered by a Participating Payor at least in part because of the Discount.

  • Requestor’s sole source of remuneration under the Proposed Arrangement would be the administrative fee paid by the Participating Payor when a Discount is received from a Network Nursing Facility.

Related to Participating Payor

  • 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;

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

  • 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 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 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.

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

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

  • 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 student means a student who has been determined to be

  • 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:

  • 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.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • 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.

  • Non-Participating Retail Health Clinic means a Retail Health Clinic which 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.

  • Non-Participating means the Policy does not participate in the profits of the participating fund of the Company

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Participating agency means any LEA, agency or institution that collects, maintains, or uses personally identifiable information, or from which information is obtained, under Part B of the IDEA.

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

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

  • 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.

  • Participating manufacturer means that term as defined in the master settlement agreement.

  • Participating Retail Store means any one of the Australian retail stores trading under the following trading names that is authorised by Breville to sell Participating Products and has been invited by the Promoter to participate in the Promotion:

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

  • Non-Participating Manufacturer means any Tobacco Product Manufacturer that is not a Participating Manufacturer.