Provider Operations Manual definition

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

  • Amendments to the Quick Reference Guide and the Louisiana Child Care Provider Operations Manual will be provided hard copy.

  • As required by its contract with DMA, the LME/PIHP shall provide information on its appeal process in its Provider Operations Manual.

  • Although your agreement with Alignment includes the regulatory requirements, a few compliance reminders are listed below, and others are included throughout this Provider Operations Manual.

  • Welcome to Alignment Healthcare! Alignment Healthcare’s (Alignment) Provider Operations Manual contains information on Alignment’s operational policy and procedures that support many of our programs and services.

  • Purpose of the Provider Operations ManualThe Provider Operations Manual describes Alignment’s policies and operating procedures.

  • 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.

  • Ta- ble 1 summarizes the available breakdowns of the FX liabilities and assets in the data.

  • Refer to the Provider Operations Manual (POM) for instructions on completing each task.

  • This Provider Operations Manual applies to IPAs, Medical Groups, and other Participating Providers who Alignment has delegated to perform certain managed care functions, such as utilization management, claims payment and credentialing, as outlined in the agreement with Alignment.


More Definitions of Provider Operations Manual

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.
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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.
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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.
Sample 1
Provider Operations Manual means the manual that is posted on the LME’s website, which has specific guidelines, instructions and requirements relating to this Contract and serves as an extension to this Contract.
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Related to Provider Operations Manual

  • Operations Manual means a manual containing procedures, instructions and guidance for use by operational personnel in the execution of their duties;

  • Project Operations Manual or “POM” means the Project Operations Manual referred to in Section I.B of Schedule 2 to this Agreement, as the said manual may be amended from time to time, with the prior written approval of the Bank, and such term includes any schedules to the POM.

  • 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.

  • PJM Manuals means the instructions, rules, procedures and guidelines established by the Office of the Interconnection for the operation, planning, and accounting requirements of the PJM Region and the PJM Interchange Energy Market.

  • Maintenance Manual shall have the meaning ascribed to it in Clause 10.7; “Maintenance Programme” shall have the meaning set forth in Clause 14.3; “Maintenance Period” shall have the meaning set forth in Clause 14.1; “Maintenance Requirements” shall have the meaning set forth in Clause14.2;

  • Customer Proprietary Network Information (“CPNI”) is as defined in the Act.

  • 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;

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • Procedures Manual means the standards and procedures manual described in Section 11.3.

  • Project Manual means the volume usually assembled for the Work which may include the bidding requirements, sample forms, and other Contract Documents.

  • Operating Manual means Exhibit A of the Conditions.

  • 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.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • Web Site Accessibility Standards/Specifications means standards contained in Title 1 Texas Administrative Code Chapter 206.

  • Operations Manager means the Contract Personnel consented to by the Director in accordance with Schedule 3 Contract Management, Section 2 Key People.

  • Customer Services means the call centre for dealing with queries about your Card. You can contact Customer Services by calling 01 693 3333, or contacting us directly.

  • Design Manual means the MOHLTC design manual or manuals in effect and applicable to the development, upgrade, retrofit, renovation or redevelopment of the Home or Beds subject to this Agreement.

  • Program services means services that include all of the following provided they are pursuant to a program agreement: program needs assessment and development, job task analysis, curriculum development and revision, instruction, instructional materials and supplies, computer software and upgrades, instructional support, administrative and student services, related school to career training programs, skill or career interest assessment services and testing and contracted services.

  • Provider panel means those providers with which a carrier contracts to provide health care services

  • system user means a natural or legal person supplying to, or being supplied by, a transmission or distribution system;

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • Passenger Services means, those railway passenger services provided by or on behalf of the Beneficiary pursuant to the permission to use track granted in accordance with the Track Access Agreement;

  • Project Implementation Manual or “PIM” means the manual containing details of financial and accounting procedures, procurement arrangements, environmental and social monitoring and mitigation arrangements, and other administrative and organizational arrangements, as shall have been agreed with the Association for purposes of Project implementation, as the same may be amended from time to time, and such term includes any schedules to the PIM;

  • flight information service means a service provided for the purpose of giving advice and information useful for the safe and efficient conduct of flights;

  • Baseline Personnel Security Standard means the pre-employment controls for all civil servants, members of the Armed Forces, temporary staff and government contractors generally.

  • Support Services means support in relation to the use of, and the identification and resolution of errors in, the Hosted Services, but shall not include the provision of training services;