Provider Operations Manual definition

Provider Operations Manual refers to the manual approved by the Department and posted on the LME/PIHP website.

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

Provider Operations Manual means the Manual posted on the LME/PIHP website and that provides specific guidelines and instructions regarding implementation of this Contract.

Provider Operations Manual means the Anthem Medi-Cal Provider Operations Manual. The Provider Operations Manual is incorporated herein by this reference and applies to all Anthem Medi-Cal Managed Care Plans.

Examples of Provider Operations Manual in a sentence

The applicable Subscriber’s Certificate should be consulted for an accurate and complete description of Covered Services and the Provider Operations Manual for clarification.
At the time of installation, the Provider or authorized person will be trained and provided one (1) Quick Reference Guide and one (1) Louisiana Child Care Provider Operations Manual.
As required by its contract with DMA, the LME/PIHP shall provide information on its appeal process in its Provider Operations Manual.
Amendments to the Quick Reference Guide and the Louisiana Child Care Provider Operations Manual will be provided hard copy.
All claims shall be adjudicated as outlined in the Provider Operations Manual and Chapter 108C of the North Carolina General Statutes.
Requests for Reconsideration by the LIP and appeals of audit determinations are as defined by Controlling Authority and as outlined in the Provider Operations Manual, and promulgated by LME/PIHP pursuant to N.C. Gen.
CONTRACTOR may contest and appeal a determination that claims were paid in error as outlined in the LME/PIHP Provider Operations Manual promulgated by the LME/PIHP pursuant to N.C. Gen.
Requests for Reconsideration by the CONTRACTOR and appeals of audit determinations are as defined by Controlling Authority and as outlined in the LME/PIHP Provider Operations Manual promulgated by LME/PIHP, pursuant to N.C. Gen.
Amendments to the Quick Reference Guide and the Louisiana Child Care Provider Operations Manual will be provided in hard copy.
All claims shall be adjudicated as outlined in the LME/PIHP Provider Operations Manual and Chapter 108C of the North Carolina General Statutes.

More Definitions of Provider Operations Manual

Provider Operations Manual means the compilation of policies, procedures, standards and specific documents pertaining to the Benefit Plan that has been compiled by Governing Board for the use and instruction of Provider, and to which Provider must adhere. The Provider Operations Manual may be unilaterally amended or modified from time to time by Governing Board.

Provider Operations Manual refers to the manual approved by the Department and posted on the LME/PIHP website. “State-funded consumer” refers to an individual who receives Mental Health, Developmental Disability, and/or Substance Abuse (MH/DD/SA) services that are paid with State funds (which may include state and/or federal block grant funds). “Unmanaged Visits” refers to visits not requiring prior authorization. CONTRACTOR enters into this contract with LME/PIHP for the purpose of providing medically necessary MH/DD/SA services to the LME/PIHP’s Enrollee(s) and agrees to comply with Controlling Authority, the conditions set forth in this Contract and all Appendices or Attachments to this Contract. CONTRACTOR is an independent contractor of LME/PIHP. This Contract is not intended and shall not be construed to create the relationship of agent, servant, employee, partnership, joint venture, or association between the parties, their employees, partners, or agents but rather CONTRACTOR is an independent contractor of the LME/PIHP. Further, neither party shall be considered an employee or agent of the other for any purpose including but not limited to, compensation for services, employee welfare and pension benefits, workers’ compensation insurance, or any other fringe benefits of employment.

Provider Operations Manual or “Provider Manual” means the provider manual and any billing manuals adopted by the BH I/DD Tailored Plan and may include, without limitation, requirements relating to billing, credentialing, utilization management, quality management, grievances and appeals, on-site reviews and State requirements, and may be unilaterally amended from time to time by the BH I/DD Tailored Plan.

Provider Operations Manual means the manual that is posted on the Partners BHM website, which has specific guidelines, instructions and requirements relating to this contract.