Plan Provider Manual definition

Plan Provider Manual means the CarePlus Health Plans, Inc. Provider Manual, as amended and revised from time to time by Plan in its discretion.
Plan Provider Manual means the HealthSun Health Plans Provider Manual, as amended and revised from time to time by Plan, and provided to MSO.
Plan Provider Manual refers to policies, procedures, programs and protocols adopted by Plan to be used by PO or Participating Provider in providing services and doing business with Plan under this Agreement, including but not limited to credentialing and re - credentialing verification processes, utilization management, quality improvement, peer review, Member grievance process or concurrent review. Pursuant to N.C. Gen. Stat. § 58- 50-285, in the event of a conflict between the Plan Provider Manual and this Contract, the Contract shall prevail.

Examples of Plan Provider Manual in a sentence

  • Contractor shall also comply with all applicable provisions of the Compliance Plan, Provider Manual, and Clinical Documentation Guide, and any and all applicable County policies and procedures.

  • This Plan Provider Manual (“PPM”) is intended to be a guideline for the provision of Covered Services to Vitality’s Medicare beneficiaries.

  • This version of the L.A. Care Health Plan Provider Manual has been created specifically for the care of L.A. Care’s Cal MediConnect members.

  • Contractor shall also comply with all applicable provisions of the Compliance Plan, Provider Manual, and Clinical Survival Guide, and any and all applicable County policies and procedures.

  • Network Provider shall comply with all billing and reporting procedures established by Plan as set forth in the Agreement or the Attachments and Schedules hereto and in the Plan Provider Manual.

  • This Non-Traditional Medicaid Plan Provider Manual describes only the limitations and reduced benefits under NTM.

  • The Agreement, this Acknowledgement, and the Health Plan Provider Manual constitute the entire Agreement between Health Plan, Provider, and Practitioner.

  • In addition to all other limitations provided in this Paragraph H (BILLING AND PAYMENT LIMITATIONS), reimbursement to Organizational Providers also shall be limited by number of authorized visits over the threshold as stipulated in the County of Los Angeles DMH Local Mental Health Plan Provider Manual.

  • The Agreement and/or the Amendment, as applicable, this Acknowledgement, and the Health Plan Provider Manual constitute the entire agreement between Health Plan, Provider, and Practitioner.

  • This version of the L.A. Care Health Plan Provider Manual has been created specifically for the care of L.A. Care’s MA-SNP members.

Related to Plan Provider Manual

  • Provider Manual means a working document, including but not limited to BCBSM published bulletins and provider notices, that provide specific guidelines and direction by which providers may meet their contractual responsibility as described in this Agreement. Provider Manuals are published on web-DENIS.

  • Plan Provider means a 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 you at the time services are rendered to you.

  • Non-Plan Provider means a Provider that does not meet the definition of Plan Provider unless otherwise specified in the definition of a particular Provider.

  • User Manual means the user guide, Help guide, and other documentation provided with the software, updated agreements provided on the website of Quick Heal (xxx.xxxxxxxxx.xxx), explanatory or other materials as provided from time to time by Quick Heal.

  • Project Manual means the volume usually assembled for the Work which may include the bidding requirements, sample forms, and other Contract Documents.

  • Project Implementation Manual or “PIM” means the manual setting out the measures required for the implementation of the Project, as the same may be amended from time to time, subject to prior approval of the Association;

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Web Site Accessibility Standards/Specifications means standards contained in Title 1 Texas Administrative Code Chapter 206.

  • Procedures Manual means the standards and procedures manual described in Section 11.3.

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other such entity administering the Medicaid program and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • CERC Manual means the manual referred to in Section I.F of Schedule 2 to this Agreement, as such manual may be updated from time to time with the agreement of the Association, and which is an integral part of the Operational Manual.

  • Operations Manual means a manual containing procedures, instructions and guidance for use by operational personnel in the execution of their duties;

  • Service Level Agreements means an agreement between NZX and a Market Participant and/or an Advisor setting out the terms and conditions of use of NZX technology and services;

  • Service Provider Materials means all works of authorship, products and materials [including, but not limited to, data, diagrams, charts, reports, specifications, studies, inventions, software, software development tools, methodologies, ideas, methods, processes, concepts and techniques] owned by, or licensed to, the Service Provider prior to the Commencement Date or independently developed by the Service Provider outside the scope of this Agreement at no expense to Transnet, and used by the Service Provider in the performance of the Services;

  • Service Level Agreement or SLA means the processes, deliverables, key performance indicators and performance standards relating to the Services to be provided by the Service Provider;

  • Service Terms means the service terms applicable to each Service, which are made part of this Agreement upon the date you elect to register for or use the applicable Service, and any subsequent modifications we make to those terms.

  • New jobs training program or “program” means the project or projects established by a community college for the creation of jobs by providing education and training of workers for new jobs for new or expanding industry in the merged area served by the community college. The proceeds of the certificates, as authorized by the Act, shall be used only to fund program services related to training programs made necessary by the creation of new jobs.

  • 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.

  • Design Manual means the MOHLTC design manual or manuals in effect and applicable to the development, upgrade, retrofit, renovation or redevelopment of the Home or Beds subject to this Agreement.

  • MERS Procedures Manual The MERS Procedures Manual, as it may be amended, supplemented or otherwise modified from time to time.

  • Maintenance Manual shall have the meaning ascribed to it in Clause 10.7; “Maintenance Programme” shall have the meaning set forth in Clause 14.3; “Maintenance Period” shall have the meaning set forth in Clause 14.1; “Maintenance Requirements” shall have the meaning set forth in Clause14.2;

  • Training program means an NCA-approved Iowa college, the Iowa law enforcement academy or an Iowa hospital approved by the department to conduct emergency medical care training.

  • Electronic and Information Resources Accessibility Standards means the accessibility standards for electronic and information resources contained in 1 Texas Administrative Code Chapter 213.

  • Web Site Accessibility Standards/Specifications means standards contained in Title 1 Texas Administrative Code Chapter 206.