PPO Provider definition

PPO Provider means an Eligible Provider, Hospital, or other facility that has a written agreement recognized by the Plan to provide health care services to Plan participants at specified costs.
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PPO Provider means a health care service provider that is contracted with and credentialed by a managed care organization to provide quality and cost effective services.
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Examples of PPO Provider in a sentence

  • The PPO Provider or Premier Provider will complete the dental Claim Form and submit it to the dental plan for reimbursement.

  • The PPO Provider will accept contracted fees as payment in full for covered services and will not balance bill if there is a difference between Submitted Fees and PPO Contracted Fees.

  • This plan is a dental PPO plan and the greatest benefits – including out-of-pocket savings – occur when you choose a PPO Provider.

  • Costs incurred by the Pediatric Enrollee for covered services with a PPO Provider apply towards the Out-of-Pocket Maximum for pediatric dental Benefits.

  • The PPO Provider or Premier Provider must accept assignment of Benefits, meaning these Providers will be paid directly after satisfaction of the Deductible and Enrollee Coinsurance.

  • You may see any Dental Provider for your covered treatment whether the Provider is a PPO Provider, Premier Provider or a Non-Delta Dental Provider.

  • Payment for covered services performed by a PPO Provider is based on the Maximum Contract Allowance.

  • Dental Out-of-Pocket Maximum means the maximum amount that a Member will pay during a Calendar Year for Pediatric dental Benefits from a PPO Provider before Delta Dental begins to pay 100% of the PPO Contracted Fee.

  • You must obtain Prior Authorization (if required) for services provided by a National PPO Provider and follow all other rules regarding Out-of-network Practitioners/Providers.

  • Our Preferred Care PPO (or PCare) Network consists of a select group of Physicians, Hospitals and other Allied Health Professionals who have contracted with Us to participate in the Blue Cross and Blue Shield of Louisiana PPO Provider Network and render services to Our Members.

Related to PPO Provider

  • New Provider means any replacement service provider or providers engaged to provide the Services (or part thereof) or substantially similar services or the Authority itself where the Services or substantially similar services or part thereof continue to be provided by the Authority after partial termination, termination or expiry of this Contract;

  • Provider is any individual or company that provides professional or technical services.

  • 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.

  • Hosting Provider means any Permitted Subcontractor that is providing any or all of the Hosted Services under this Contract.

  • System Provider means and includes a person who operates an authorised payment system as defined in Section 2 of the Payment and Settlement Systems Act, 2007;