Preferred Provider List definition

Preferred Provider List means the list that identifies each Preferred Provider that is approved by CMS for participation in the Model for a Performance Year that is established in accordance with Section 4.02 and updated from time to time in accordance with Sections 4.03 and 4.04.
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Preferred Provider List means the list that identifies each Preferred Provider that is approved by CMS for participation in the Next Generation Model, specifies which Preferred Providers, if any, have agreed to receive an AIPBP Fee Reduction or PBP Fee Reduction, and designates the Benefit Enhancements, if any, in which each Preferred Provider participates, as updated from time to time in accordance with Section IV.D and IV.E of this Agreement.
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Examples of Preferred Provider List in a sentence

  • State that the individual or entity and the TIN through which it bills Medicare will be identified on the Proposed Revised Preferred Provider List.

  • For any individual or entity on a Proposed Revised Preferred Provider List, if CMS determines that the individual or entity does not satisfy the criteria in paragraphs (1) through (4) of Section 4.01.B.

  • For each Performance Year that the ACO selects to participate in the APO, the arrangement prohibits a Participant Provider that is added to the Participant Provider List during the Performance Year or a Preferred Provider that is added to the Preferred Provider List during a Performance Year from participating in the APO for the Performance Year in which the Participant Provider or the Preferred Provider is so added.

  • By a date specified by CMS, the ACO shall furnish written notification to the executive of any TIN through which an individual or entity on the Proposed Revised Participant Provider List or Proposed Revised Preferred Provider List bills Medicare.

  • If the ACO selects to provide a Benefit Enhancement for a Performance Year, the ACO’s Participant Providers and Preferred Providers, as indicated on the relevant Participant Provider List and Preferred Provider List under Article IV, may submit claims for services furnished pursuant to such Benefit Enhancement as described in this Article X during the Performance Year for which the ACO selected to provide the Benefit Enhancement.

  • If the ACO has selected to participate in the APO for the ACO’s first Performance Year as described in Section 8.01, the ACO shall certify that the ACO has obtained written confirmation that each individual and entity listed on either the Proposed Participant Provider List or the Proposed Preferred Provider List as participating in the APO at the start of the ACO’s first Performance Year has consented to participate in the APO for that Performance Year in accordance with this Section 12.02.E.

  • By a date specified by CMS, the ACO shall furnish written notification to each individual or entity the ACO wishes to include on the Proposed Revised Preferred Provider List.

  • If the ACO has selected PCC Payment as its Capitation Payment Mechanism, the arrangement prohibits a Participant Provider that is added to the Participant Provider List during a Performance Year or a Preferred Provider that is added to the Preferred Provider List during a Performance Year from participating in the ACO’s selected Capitation Payment Mechanism for the Performance Year in which the Participant Provider or Preferred Provider is so added.

  • CMS shall conduct a Program Integrity Screening for each individual and entity on the Proposed Revised Participant Provider List and the Proposed Revised Preferred Provider List.

  • If the ACO has selected TCC Payment as its Capitation Payment Mechanism, the arrangement prohibits a Participant Provider that is added to the Participant Provider List during a Performance Year or a Preferred Provider that is added to the Preferred Provider List during a Performance Year from participating in the ACO’s selected Capitation Payment Mechanism for the Performance Year in which the Participant Provider or Preferred Provider is so added.