Provider Payor definition

Provider Payor means any medical services provider reimbursed by an HMO, PPO or managed care program, commercial insurer, Medicare, Medicaid, or CHAMPUS organized under the laws of any jurisdiction in the United States, having its principal office in the United States.
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Provider Payor means any medical services provider (including but not limited to hospitals and urgent care units) for which a Provider Affiliate or a Provider Physician has provided services by contract resulting in the generation of a Receivable to be reimbursed by an HMO, PPO or other similar managed care program, commercial insurer, Medicare, Medicaid, CHAMPUS, Governmental Authority or other governmental program created or organized under the laws of any jurisdiction in the United States, having its principal office in the United States.
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Examples of Provider Payor in a sentence

  • Where a request for refund is contested by Provider, Payor may not request that the refund be paid any sooner than six (6) months from the date of Provider’s receipt of the request.

  • CIIPA also may, from time to time, send Provider Payor specific appendices that shall be incorporated into the terms of this Agreement to the extent that the Provider provides Covered Services to such Payor’s Covered Persons.

  • When Payor has finally adjudicated the repriced Network Provider claims for Participants, it will remit all Benefit Plan payments to ACS for each such Network Provider, Payor will pay ACS the repriced amount, less applicable Participant Expenses (copayments and deductibles).

  • Provider, Payor and UBH shall comply with applicable sections of Ohio laws and regulations as they relate to the payment and processing of claims, including those set forth in Ohio Rev.

  • The relationship between or among Health Plan, Company, Provider, Payor and any Contracted Provider hereunder is that of independent contractors.

  • Provider, Payor and UBH shall comply with all applicable laws that govern the payment of claims for health care services.

  • Provider, Payor and UBH shall comply with applicable sections of Wisconsin laws and regulations as they relate to the payment and processing of claims, including those set forth in Wisconsin Statute Section 628.46.

  • Provider, Payor and UBH shall comply with the requirements set forth in C.R.S. §▇▇-▇▇-▇▇▇ (4.5) with regard to making adjustments to claims.

  • NM Referrals to Provider NM Admissions to Provider Payor Mix % Medicare % Medicaid % Commerical % Self- Pay Performance M Referral Ac 30-Day Av The NM NETWORK offers the NM NETWORK Programs listed below.

  • If the appeal is resolved in favor of Provider, Payor must pay the amount owed, plus interest at 12% per year, on or before the 30th calendar day following Provider’s notification of the determination on the appeal.

Related to Provider Payor

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

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

  • Provider Agreements means all participation, provider and reimbursement agreements or arrangements now or hereafter in effect for the benefit of Tenant or any Manager in connection with the operation of any Facility relating to any right of payment or other claim arising out of or in connection with Tenant’s participation in any Third Party Payor Program.

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • Provider contract means any contract between a provider and a carrier (or a carrier's network,