Provider in the same or similar specialty definition

Provider in the same or similar specialty means the practice specialty of a provider, as identified by the plan or issuer consistent with the plan’s or issuer’s usual business practice, except that, with respect to air ambulance services, all providers of air ambulance services are considered to be a single provider specialty.
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Examples of Provider in the same or similar specialty in a sentence

  • Qualified Payment Amount means the median of the contracted rates recognized by the Plan, or recognized by all plans serviced by the Plan’s claims administrator, for the same or similar item of service provided by a Provider in the same or similar specialty in the same geographic region.

  • A Participating Provider may also request a second opinion in regard to covered Services by referring you to another Participating Provider in the same or similar specialty.

  • If the Appeal of an Adverse Determination is denied and, within ten (10) working days from the denial, the Appeal denial will be reviewed by a Participating Provider in the same or similar specialty that typically manages the medical, dental or specialty condition, procedure, or treatment under discussion for review of the Adverse Determination.

  • If the Appeal of an Adverse Determination is denied and, within ten (10) working days from the denial, Your Provider sets forth in writing good cause for having a particular type of specialty Provider review the case, the Appeal denial will be reviewed by a Participating Provider in the same or similar specialty that typically manages the medical, dental or specialty condition, procedure, or treatment under discussion for review of the Adverse Determination.

  • The Qualifying Payment Amount will be based on the median of the contracted rate for the same or similar item or service provided by a Provider in the same or similar specialty in the same geographic region.

Related to Provider in the same or similar specialty

  • Provider Organization means a group practice, facility, or organization that is:

  • Health care organization ’ means any person or en-

  • Participating Home Infusion Therapy Provider means a Home Infusion Therapy Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Established geographic service area means a geographic area, as approved by the Commissioner and based on the carrier's certificate of authority to transact insurance in this state, within which the carrier is authorized to provide coverage;

  • Non-Participating Home Infusion Therapy Provider means a Home Infusion Therapy Provider who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Expansion to an existing manufactured home park or subdivision means the preparation of additional sites by the construction of facilities for servicing the lots on which the manufactured homes are to be affixed (including the installation of utilities, the construction of streets, and either final site grading or the pouring of concrete pads).

  • Communications service provider means a service provider that provides broadband service.

  • Primary care-giver means a person who assumes the principal role of providing care and attention to a child.

  • Telecommunications service provider means that term as defined in Section 219a of the Michigan Penal Code, supra, as may be amended from time to time. As of January 2012, "Telecommunications Service Provider" is defined to mean any of the following:

  • Non-Methane Organic Gases or “NMOG” means the total mass of oxygenated and non-oxygenated hydrocarbon emissions.

  • Extended foster care services means residential and other

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Health service area or “HSA” refers to the distinct geographic regions described in Section 4.1.4 or the Vermont Blueprint for Health Manual.

  • Specified anatomical areas means and includes:

  • Electric Reliability Organization or “ERO” means the organization that is certified by the Commission under Section 39.3 of its regulations, the purpose of which is to establish and enforce Reliability Standards for the Bulk Power System in the United States, subject to Commission review. The organization may also have received recognition by Applicable Governmental Authorities in Canada and Mexico to establish and enforce Reliability Standards for the Bulk Power Systems of the respective countries.

  • Existing manufactured home park or subdivision means a manufactured home park or subdivision for which the construction of facilities for servicing the lots on which the manufactured homes are to be affixed (including, at a minimum, the installation of utilities, the construction of streets, and either final site grading or the pouring of concrete pads) is completed before the effective date of the floodplain management regulations adopted by a community.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Mobile telecommunications service means the same as that term is defined in the Mobile Telecommunications Sourcing Act, 4 U.S.C. Sec. 124.

  • Ambulance service provider means Latrobe Health Services recognises the following providers for the purposes of paying benefits:

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Anatomical gift means a donation of all or part of a human body to take effect after the donor's death for the purpose of transplantation, therapy, research, or education.

  • Mental health services provider means an individual, licensed or unlicensed, who performs or purports to perform mental health services, including a:

  • Floodplain or flood-prone area means any land area susceptible to being inundated by water from any source. See "Flood or flooding."

  • 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.

  • Drug-dependent person means a person who is using a

  • Severe food allergy means a dangerous or life-threatening reac- tion of the human body to a food-borne allergen introduced by in- halation, ingestion, or skin contact that requires immediate medical attention.