Participating Provider definition

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 Provider means a Plan Hospital or Professional Provider which 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 Plan facility or Professional Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider.

Participating Provider means a provider who, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other than coinsurance, copayments or deductibles, directly or indirectly from the health carrier.

Examples of Participating Provider in a sentence

• OHIOHEALTHY PROGRAM ATTACHMENT TO PARTICIPATING PROVIDER AGREEMENT (Individual Provider) The provisions of this OhioHealthy Program Attachment (this “Attachment”) to Participating Provider Agreement, including the payment terms set forth therein, are subject to the terms set forth in the Participating Provider Agreement by and between OhioHealthy Medical Plan, Inc., OhioHealthy (the “Agreement”) which by this reference is hereby incorporated herein.

• Contractor also represents that it is not aware of any conflicts of interest of any Participating Provider or any basis for potential violations of Contractor or Participating Provider with respect to laws, rules and regulations that govern referrals required for the provision of certain Covered Services, including Federal and State anti-kickback and anti-self-referral laws, rules and regulations.

• If Covered California’s centralized provider directory is not operational, Contractor shall continue to provide Participating Provider information to Covered California on a monthly basis.

• When a Covered Service is received from a Participating Provider, the Subscriber pays only the Deductible and/or Coinsurance amount applicable to that service.

• Contractor acknowledges that Covered California may use Contractor’s Participating Provider data for any non-commercial purposes.

More Definitions of Participating Provider

Participating Provider means, for purposes of this Amendment only, with respect to a Covered Service, a facility, physician or other health care provider who has a contractual relationship with BCBSMT setting a rate (above which the provider cannot bill the member) for furnishing such item or service under the Contract to which this Amendment is attached regardless whether the provider is considered a preferred or in-network provider for purposes of in-network or out-of-network benefits under the subject Contract.

Participating Provider means a Hospital or Professional Provider that either: (i) has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield to provide services to participants in the benefit program, or; (ii) has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider in the benefit program.

Participating Provider. A Provider who has a contract with Us to provide health care services to You. A list of Participating Providers and their locations is available on Our website at xxx.xxxxxx.xxx or upon Your request to Us. The list will be revised from time to time by Us. Physician or Physician Services: Health care services a licensed medical Physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates. Plan Year: A calendar year ending on December 31 of each year. Preauthorization: A decision by Us prior to Your receipt of a Covered Service, procedure, treatment plan, or device that the Covered Service, procedure, treatment plan, or device is Medically Necessary. We indicate which Covered Services require Preauthorization in the Schedule of Benefits section of this Contract. Premium: The amount that must be paid for Your dental insurance coverage. Premium Tax Credit: Financial help that lowers Your taxes to help You and Your family pay for private dental insurance. You can get this help if You get health insurance through the NYSOH and Your income is below a certain level. Advance payments of the tax credit can be used right away to lower Your monthly Premium. Primary Care Dentist (“PCD”): A participating dentist who directly provides or coordinates a range of dental services for You. Provider: An appropriately licensed, registered or certified dentist, dental hygienist, or dental assistant under Title 8 of the New York State Education Law (or other comparable state law, if applicable) that the New York State Insurance Law requires to be recognized who charges and bills patients for Covered Services. The Provider’s services must be rendered within the lawful scope of practice for that type of Provider in order to be Covered under the Contract. Referral: An authorization given to one Participating Provider from another Participating Provider (usually from a PCD to a Specialist) in order to arrange for additional care for a Member. A Referral can be transmitted electronically or by Your Provider completing a paper Referral form.

Participating Provider means an individual or entity that has entered into an agreement with Health Plan or a Health Plan contractor to provide or arrange for the provision of Covered Services to Members.

Participating Provider means a health care

Participating Provider means a provider that has a contractual relationship with an MCE and is on their panel of providers.

Participating Provider means an entity that meets the standards and requirements set forth by DMAS and has a current, signed provider participation agreement with DMAS.