Provider Operations Manual definition

Provider Operations Manual refers to the manual approved by the Department and posted on the LME/PIHP website.
Sample 1Sample 2Sample 3
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.
Sample 1
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

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.

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

  • 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.

  • 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.

  • All claims shall be adjudicated as outlined in the LME/PIHP Provider Operations Manual and Chapter 108C of the North Carolina General Statutes.

  • The contents of Alignment's Provider Operations Manual supplements the IPA/Medical Group Participating Provider Services Agreement and its addendums.

  • All claims shall be adjudicated as outlined in the Provider Operations Manual and Chapter 108C of the North Carolina General Statutes.

  • The Provider Operations Manual explains the policies and administrative procedures of CMSP.


More Definitions of Provider Operations Manual

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.
Sample 1
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.
Sample 1
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.
Sample 1
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.
Sample 1

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;

  • 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.

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

  • 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.

  • 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

  • Project Implementation Manual or “PIM” means the manual setting out the measures required for the implementation of the Project, as the same may be amended from time to time, subject to prior approval of the Association;