Referral Provider definition

Referral Provider means a provider, who is not the enrollee’s PCP, to whom an enrollee is referred for covered services.
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Referral Provider means a provider, who is not the enrollee’s PCP, to whom an enrollee is referred for covered services.‌
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Referral Provider means a Participating Provider who performs Covered Services that are not Primary Care Covered Services, within their designated specialty(s) as defined in their Provider Agreement with COMPANY.
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Examples of Referral Provider in a sentence

  • Because telephone central office boundaries do not necessarily match the boundaries used by an Approved Community Information and Referral Provider, providing 211 Service for the entire area served by a central office may result in the Approved Community Information and Referral Service Provider receiving calls from geographical areas it does not serve.

  • To the Company’s Knowledge, neither the Company nor any Company Subsidiary has received any written notice from any Top Referral Provider that such Top Referral Provider intends to terminate, cancel, not to renew, or to otherwise seek to modify or amend in any material and adverse respect (including any material reduction or change to pricing terms) any such Third Party Referral Contract to which it is a party.

  • Section 4.24 of the Company Disclosure Letter lists (a) each Third Party Referral Provider that individually or with its Affiliates was one of the top ten (10) largest Third Party Referral Providers of the Company Business based on net revenue of the Company for the twelve month period ended December 31, 2015 (the “Top Referral Providers”); and (b) the total dollar amount of net revenue attributable to each such Top Referral Provider for such period.

  • Special Provider ArrangementsUChicago Student Wellness Referral Provider Arrangements have agreed to accept special reduced reimbursement rates for treatment rendered to Insureds.

  • The Company has delivered to the Purchaser a true, accurate and complete copy of each Third Party Referral Contract with a Top Referral Provider.

  • If the decision of the PacifiCare Claims Manager or the Quality Improvement Committee described in Section 9.6 is adverse to the Referral Provider, notice of the decision shall be given to Medical Group and the Referral Provider.

  • Program eligible women who have abnormal breast and/or cervical screening results are eligible for follow-up diagnostic/treatment services when referred by a WVBCCSP Screening Provider to a WVBCCSP Referral Provider.

  • THE LEAD STORE Inc., may be selling to other businesses, firms, or corporations within the same marketplace as the Company, THE LEAD STORE Inc., as an Independent Contracted Lead Service and Referral Provider will provide a thirty (30) day Exclusive to the Company for all Leads provided to Company, business, firm, or corporation.

  • She commented that Nancy Marquez-Suarez and Gaby Banos-Galvan did a great job; it was a great class and she hopes leadership projects will provide an opportunity for graduates to continue to work with the Oakley community.

  • AND REFERRAL PROVIDERS - Should a dispute arise between Medical Group and a Referral Provider concerning a claim for payment for Medical Services rendered to Members, Medical Group or the Referral Provider may submit a written complaint to PacifiCare.


More Definitions of Referral Provider

Referral Provider means a Contracted Physician who is professionally qualified to practice his/her designated specialty and whose agreement with HPSM includes responsibility for providing Covered Services in his/her designated specialty.
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Referral Provider means the Party that delivers a Proposed Referral.
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Related to Referral Provider

  • Medical provider means a medical service provider, a hospital, a medical clinic, or a vendor of medical services.

  • Professional Provider means a Physician, Dentist, Podiatrist, Psychologist, Chiropractor, Optometrist or any Provider designated by the Claim Administrator or another Blue Cross and/or Blue Shield Plan.

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.

  • Account Information Service Provider means a payment service provider pursuing business activities as referred to in point (8) of Annex I;

  • Information Service Provider A provider of Information Service. Information Service Provider includes, but is not limited to, Internet Service Providers (ISPs).

  • Participating Provider means an Administrator Hospital or Professional Provider which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or an Administrator facility which has been designated by the Claim Administrator as a Participating Provider.

  • Data Provider means a Participant that is registered to provide information to GS1 South Africa for use through the Verified by GS1 Services.

  • 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.

  • Individual provider means an individual provider as defined

  • 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.

  • Basic health plan services means that schedule of covered

  • Participating Orthotic Provider means an Orthotic 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.

  • Information Recipient has the meaning stated in Section 4.9(a).

  • account information service means an online service to provide consolidated information on one or more payment accounts held by the payment service user with either another payment service provider or with more than one payment service provider;

  • Data Services The Customer will receive a discount equal to 25% for the following Data Services: Access: Standard VBS2 Guide local loop charges for DS-1 Access and DS-3 Access Service.

  • Information Service is the offering of a capability for generating, acquiring, storing, transforming, processing, retrieving, utilizing, or making available information via Telecommunications, and includes electronic publishing, but does not include any use of any such capability for the management, control, or operation of a Telecommunications system or the management of a Telecommunications Service.

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • Hosting Services means the provision, administration, and maintenance of servers and related equipment, the provision of bandwidth at the hosting facility, and the operation of the Application for access by Customer Users to be provided by the relevant hosting service provider.

  • Education service provider means an education management organization, school

  • 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.

  • financial service provider means a person engaged in the business of providing financial services in terms of authorisation issued or registration granted by a financial sector regulator;

  • New Provider means any replacement service provider or providers engaged to provide the Services (or part thereof) or substantially similar services or the Authority itself where the Services or substantially similar services or part thereof continue to be provided by the Authority after partial termination, termination or expiry of this Contract;

  • Emergency medical services provider means a person who has received formal training in prehospital and emergency care, and is licensed to attend any person who is ill or injured or who has a disability. Police officers, firefighters, funeral home employees and other persons serving in a dual capacity one of which meets the definition of “emergency medical services provider” are “emergency medical services providers” within the meaning of this chapter.

  • Self-Administration of Medication means the individual manages and takes his or her own medication, identifies his or her medication and the times and methods of administration, places the medication internally in or externally on his or her own body without staff assistance upon written order of a physician, and safely maintains the medication without supervision.

  • Information Recipients has the meaning stated in Section 4.9(a).

  • Family child care provider means a person who: (a) Provides