Participating Professional Provider definition

Participating Professional Provider means a Professional Provider who has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to partici­ pants in a Participating Provider Option program or a Professional Provider who has been designated by a Blue Cross and/or Blue Shield Plan as a Par­ ticipating Professional Provider.
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Participating Professional Provider means a Professional Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in a Partic­ ipating Provider Option program or a Professional Provider who has been
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Participating Professional Provider means a Professional Provider who has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide Covered Services to participants in the Blue Options PPO℠ benefit program at the time Covered Services are rendered.
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Examples of Participating Professional Provider in a sentence

  • PARTICIPATING PROFESSIONAL PROVIDER…..means a Professional Provider who has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide Covered Services to participants in benefit program at the time Covered Services are rendered or a Professional Provider who has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Professional Provider.

  • Medical Care rendered by a Participating Professional Provider in charge of the Member’s case while an Inpatient in a Participating Facility Provider that is a Hospital, Rehabilitation Hospital or Skilled Nursing Facility for a condition not related to Surgery or pregnancy, or except as specifically provided.

  • Benefits will be provided for injectable medications required in the treatment of an injury or illness administered by a Participating Professional Provider.

  • However, if you willfully choose to receive Covered Services from a Non-Participating Provider when a Participating Professional Provider is available or you or the Non-Participating Provider rejects the assignment of benefits, the above provision will not apply to you.

  • The Primary Care Physician will provide a Referral, when one is required, to a Participating Professional Provider when the Member’s condition requires a Specialist's Services.

  • How To Obtain A Standing ReferralIf the Member has a life-threatening, degenerative or disabling disease or condition, they may receive a Standing Referral to a Participating Professional Provider to treat that disease or condition.

  • In order to receive the highest level of payment from The Plan, the Member must receive services from a Blue Focus POS Participating Professional Provider who is an obstetrician or gynecologist.

  • Benefits are payable if the Qualifying Clinical Trial is conducted by a Participating Professional Provider, and conducted in a Participating Facility Provider.

  • If the Plan terminates a Participating Professional Provider, that provider is still obligated under his/her contract to complete such professional services which he/she has commenced, unless the Plan makes such reasonable and appropriate provisions for the assumption of such services by another contracting Professional Provider.

  • The Covered Person is responsible within sixty (60) days of the date in which the Carrier finalizes such services to pay, or make arrangements to pay, such amounts to the Preferred and Participating Professional Provider.


More Definitions of Participating Professional Provider

Participating Professional Provider means a Professional Provider who
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Participating Professional Provider means a Professional Provider who has a written agreement with the Claim Administrator to provide services to participants in a Participating Provider Option program or a Professional
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Related to Participating Professional Provider

  • Professional Provider means a Physician, Dentist, Podiatrist, Psychologist, Chiropractor, Optometrist or any Provider designated by the Claim Administrator or another Blue Cross and/or Blue Shield 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.

  • Participating Prescription Drug Provider means an independent retail Pharmacy, chain of retail Pharmacies, mail-order Pharmacy or specialty drug Pharmacy which has entered into an agreement to provide pharmaceutical services to participants in the benefit program. A retail Participating Pharmacy may or may not be a select Participating Pharmacy as that term is used in the Vaccinations Obtained Through Participating Pharmacies section.

  • Designated mental health professional means a mental health

  • Participating Product means any of the Breville products listed in the table below by model name and number that are supplied by Breville in Australia and sold directly by Breville or by a Participating Retail Store:

  • Individual provider means an individual provider as defined