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

  • Next Generation Participants and Preferred Providers will be included on the Participant List or Preferred Provider List only upon the prior written approval of CMS.

  • If CMS approves the request, the individual or entity will be added to the Preferred Provider List effective on the date the addition is approved by CMS.

  • CMS shall notify the ACO if it chooses to remove an individual or entity from the Participant List or Preferred Provider List, and such notice shall specify the effective date of removal.

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

  • CMS shall maintain the Participant List and Preferred Provider List in a manner that permits the ACO to review the list.

  • City employees with MH and SUD conditions should not be required to prove on a case-by-case basis that this benchmark violates the Parity Act.

  • 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.

  • If CMS notifies the ACO that a SNF or Swing-Bed Hospital has not been approved for participation in the 3-Day SNF Rule Waiver Benefit Enhancement under this Section XI.B, but the provider is otherwise eligible to be a Next Generation Participant or Preferred Provider, the ACO may either remove the provider from the Participant List or Preferred Provider List, or amend the relevant list to reflect that the provider will not participate in the 3-Day SNF Rule Waiver Benefit Enhancement.

  • 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.

  • 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.

Related to Preferred Provider List

  • Preferred Provider or “Network Provider” means a doctor, hospital, medical facility or other provider of health care which is included in a network which has been designated by the Fund to render health related services to Fund participants.

  • Preferred Provider Organization (PPO) means a health insurance issuer's or carrier's insurance policy that offers covered health care services provided by a network of providers who are contracted with the issuer or carrier (“in-network”) and providers who are not part of the provider network (“out-of-network”).

  • Registered Provider means a registered provider of social housing (see section 80 of the Housing and Regeneration Act 2008);

  • Related provider trust means a titling trust or other trust established by a licensed viatical settlement provider or a financing entity for the sole purpose of holding the ownership or beneficial interest in purchased policies in connection with a financing transaction. The trust shall have a written agreement with the licensed viatical settlement provider under which the licensed viatical settlement provider is responsible for ensuring compliance with all statutory and regulatory requirements and under which the trust agrees to make all records and files related to viatical settlement transactions available to the commissioner as if those records and files were maintained directly by the licensed viatical settlement provider.

  • Applied Provider Advance has the meaning assigned to such term in Section 2.06(a).

  • Unapplied Provider Advance means any Provider Advance other than an Applied Provider Advance.

  • Preferred Proponent(s means the Proponent(s) selected by the Evaluation Team to enter into negotiations for a Contract;

  • Qualified provider means a person or business experienced in the design, implementation, and installation of energy conservation measures. A qualified provider to whom the contract is awarded shall give a sufficient bond to the school district for its faithful performance.

  • Derivative Provider Trigger Event means (i) an Event of Default with respect to which Party A is a Defaulting Party, (ii) a Termination Event with respect to which Party A is the sole Affected Party or (iii) an Additional Termination Event with respect to which Party A is the sole Affected Party.

  • Preferred Proponent means the Proponent that is invited into negotiations in accordance with the evaluation process set out in this RFP;

  • Approved provider means a provider of services registered with the appropriate association or organization to render services to a member and approved by Latrobe to render services to its members.

  • 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.

  • 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;

  • Patient Data means any electronic data, information or material about a Patient entered into the Software.

  • 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.

  • Swap Provider Trigger Event A Swap Termination Payment that is triggered upon: (i) an Event of Default under the Interest Rate Swap Agreement with respect to which the Swap Provider is a Defaulting Party (as defined in the Interest Rate Swap Agreement), (ii) a Termination Event under the Interest Rate Swap Agreement with respect to which the Swap Provider is the sole Affected Party (as defined in the Interest Rate Swap Agreement) or (iii) an Additional Termination Event under the Interest Rate Swap Agreement with respect to which the Swap Provider is the sole Affected Party.

  • ALI Database A database used in providing 911 Service which stores information associated with End User customers’ telephone numbers or Shell Records.

  • Hospital purchaser/provider agreement (HPPA agreement) means a negotiated agreement entered between the fund and the hospital for the cost of hospital treatment.

  • Training provider means an organization meeting the eligibility conditions as mentioned in Data Sheet and selected in accordance with the criteria set forth for the purpose.

  • Companion Distribution Account shall have the meaning assigned to such term in the Lead Securitization Servicing Agreement.

  • Central Contractor Registration (CCR) database means the primary Government repository for Contractor information required for the conduct of business with the Government.

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Provider fee means the consideration paid for a service contract.

  • Covered Program means an education program or activity over which the College exercised substantial control over both the Respondent and the context in which the sexual harassment occurred.

  • Provider Personnel means all persons employed or engaged by the Provider together with the Provider’s servants, agents, consultants and Sub-Contractors (and all persons employed by any Sub-Contractor together with the Sub-Contractor’s servants, consultants, agents, Provider’s and Sub-Contractors) used in the performance of its obligations under this Agreement;

  • Series Enhancement means the rights and benefits provided to the Trust or the Investor Certificateholders of any Series or Class pursuant to any letter of credit, surety bond, insurance policy, cash collateral guaranty, subordinated interest in the Trust Assets, cash collateral account, collateral interest, spread account, guaranteed rate agreement, maturity liquidity facility, tax protection agreement, interest rate swap agreement, interest rate cap agreement or other similar arrangement. The subordination of any Series or Class to another Series or Class shall be deemed to be a Series Enhancement.