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/PHYS and/or Participating Practitioners.
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Examples of Participating Payor in a sentence

  • 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.

  • 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.

  • If the student elects to attend another high upon entering ninth or tenth grade, he/she shall be ineligible for ninety school days.

  • A healthy ocean ecosystem is fundamental to the health of our regional economies and communities.

  • 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.

  • In collecting balances from third parties and negotiating with third parties, Participating Practitioner is not required to accept the Reimbursement Rates as payment in full unless the third party payor is a Participating Payor.

  • Furthermore, Participating Practitioner agrees that if a Tax Identification Number is used for billing Participating Payors for Covered Services, all bills submitted using that Tax Identification Number may be subject to the terms of this Agreement and Participating Payor Agreements.

  • The parties to this Agreement each recognize and acknowledge a responsibility to Members, Member Groups, Participating Payors and to each other to assure that the professional and administrative services made available as a result of this Agreement, Member Agreements and Participating Payor Agreements are of high quality.

  • Whenever Practitioner is found by Participating Payor, its designees or the California Board of Chiropractic Examiners to have provided excessive, wasteful or fraudulent care or administration of billing.

  • In addition, Practitioner shall notify employees that the Practitioner’s relationship to the Participating Payor is terminated at the time Practitioner terminates this Agreement.

Related to Participating Payor

  • Participating FFI means an FFI that, as from the effective date of any rules requiring withholding on "passthru payments" (as such term is defined pursuant to Sections 1471 through 1474 of the Code and any regulations thereunder or official interpretations thereof), meets the requirements of Section 1471(b) of the Code and any regulations or other official guidance issued thereunder and that has not elected to be withheld upon pursuant to Section 1471(b)(3) of the Code.

  • 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 in kindergarten through

  • Participating Country’ means any country that the Association determines meets the requirements set forth in Section 10 of Resolution No. 183 of the Board of Governors of the Association, adopted on June 26, 1996; and ‘Participating Countries’ means, collectively, all such countries.”

  • 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;