Referring Provider definition

Referring Provider means a Provider who Refers an eligible Participant to CTA or EST. For avoidance of doubt, it does not include referrals from Workforce Australia Services or Yarrabah Employment Services to Transition to Work.
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Referring Provider means a provider who evaluates a recipient, determines the need for a consultation, and arranges the services of a consulting provider for the purpose of diagnosis or treatment;
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Referring Provider means any site personnel who regularly pre-screen medical data or charts for potential study participants. They do NOT have to be licensed practitioners, but are anyone who regularly refers patients into studies.
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Examples of Referring Provider in a sentence

  • Although ordering or referring-only providers do not submit claims to TMHP for rendered services, the ordering or referring-only provider’s NPI is required on claims that are submitted by the billing providers that render the services or provide the supplies or services.Refer to: Subsection 6.4.2.4, “Ordering or Referring Provider NPI” in “Section 6: Claims Filing” (Vol.

  • X X X X 15 C 53 Referring Provider ID Type A code identifying the type of ID provided in Referring Provider ID above.

  • For example, 1 = NPI 6 = Internal ID (Plan Specific) 9 = NAPB Number (for pharmacy claims only) X X X X X 1 N 52 Referring Provider ID A unique identifier for the provider.

  • CMS 1500 FormIf applicable, enter the Authorization Number (Field 23) and the Name of the Referring Provider (Field 17) on the claim form, to ensure efficient claims processing and handling.

  • A new sequence number is issued each time a recipient receives a new card.100Invalid Referring Provider Number101Restricted Recipient No Auth118MCCP Recipient No Auth35M/I Primary Care Provider ID00240588(8 digit MMIS identification number of the provider to which a recipient is restricted).

  • In addition, they do not verify the Referring Provider for managed care enrollees and clients that are restricted to certain Providers.

  • The exchange of a Covered Person’s information from one eligible referring licensed provider (for purposes of Telemedicine outlined herein, the "Referring Provider") site to another eligible consulting licensed Provider (for purposes of Telemedicine outlined herein, the "Consulting Provider") site for the purpose of providing medical care to a Covered Person in circumstances in which in-person, face-to-face contact with the Consulting Provider is not necessary.

  • Telehealth does not require two-way audio or video consultations between a Referring Provider and Consulting Provider, as these terms are defined in paragraph 2.85.

  • For example, an entry for an Optometrist whose license number is V867 would be: 0560U000867 (Profession Code + 0U + Zero fill+ License Number).NOTE: The Referring Provider # prompt will be displayed only if the prompt for the Ordering Provider is bypassed.REFERRING PRV #Must be entered if the client is in the Restricted Recipient Program and the transaction is not done by the primary provider.

  • NOTE: for electronic claims using version 5010 or later, this information is reported in Loop ID 2310F – Referring Provider Name.


More Definitions of Referring Provider

Referring Provider. The Provider who has evaluated the Member, determined the need for a consultation (or other service), and has arranged the services of the consulting provider for the purpose of diagnosis and/or treatment. Reinsurance: An agreement whereby the Contractor transfers risk or liability for losses, in whole or in part, sustained under this Contract. A reinsurance agreement may also exist at the Provider level. Remedial Action: Action required immediately to remedy a situation until a thorough investigation and a permanent solution is implemented. When remedial actions are necessary, the actions and the resources required must be listed and the steps that must be taken immediately to avoid any further adverse effects are explained. All actions taken are documented and become part of the ‘Action Plan’ section of the Corrective Action/Preventive Action actions. If a remedial action is all that is needed, a rationale for that decision and appropriate follow up must be documented.
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Related to Referring Provider

  • 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.

  • 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;

  • 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.

  • Hub Provider means an entity that (i) provides Common Channel Signaling (SS7) connectivity between the networks of service providers that are not directly connected to each other; or (ii) provides third party database services such as LIDB. The SS7 messages received by Hub Providers are accepted or rejected by the Hub Provider depending on whether a contractual arrangement exists between the Hub Provider and the message originator (sender) and whether the message originator has contracted for the type of SS7 messages being submitted for transmission to the Hub Provider.

  • Payment Initiation Service Provider or “PISP” means an authorised third party provider which provides a service that allows that third party to pass payment instructions to us on your behalf in relation to your Account.

  • Nonparticipating provider means a person, health care provider, practitioner, facility, or entity, acting within their scope of practice, that does not have a written contract to participate in a managed health care system's provider network, but provides health care services to enrollees of programs authorized under this chapter or other applicable law whose health care services are provided by the managed health care system.

  • Housing Provider means, with respect to a HOME Development, Local Government, consortia approved by HUD under 24 CFR Part 92, for-profit and Non-Profit Developers, and qualified CHDOs, with demonstrated capacity to construct or rehabilitate affordable housing.

  • Bona fide physician-patient relationship means a treatment or counseling relationship between a physician and patient in which all of the following are present:

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

  • Behavioral health provider means a person licensed under 34 chapter 18.57, 18.57A, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79

  • Content Provider means any video programming provider of copyrighted works for transmission to Licensed Products and the copyright owners of such work.

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

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Hedging Provider any Person that has entered into a Hedging Agreement with a Grantor with the obligations of such Grantor thereunder being secured by one or more Loan Documents, as designated by the Borrower in accordance with Section 8.4 hereof (provided that no Person shall, with respect to any Hedging Agreement, be at any time a Hedging Provider with respect to more than one Credit Facility).

  • Optional Extended Local Calling Scope Arrangement Traffic is traffic that under an optional Extended Local Calling Scope Arrangement chosen by the Customer terminates outside of the Customer’s basic exchange serving area.

  • Medically Necessary Services means those covered services that are, under the terms and conditions of the contract, determined through contractor utilization management to be:

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

  • Background radiation means radiation from cosmic sources; naturally occurring radioactive materials, including radon (except as a decay product of source or special nuclear material); and global fallout as it exists in the environment from the testing of nuclear explosive devices or from past nuclear accidents such as Chernobyl that contribute to background radiation and are not under the control of the licensee. “Background radiation” does not include sources of radiation from radioactive materials regulated by the agency.

  • Non-Administrator Dialysis Facility means a Dialysis Facility which does not have an agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan but has been certified in accordance with the guidelines established by Medicare.

  • Participating Prescription Drug Provider means an independent retail Pharmacy, chain of retail Pharmacies, mail-order Pharmacy or specialty drug Pharmacy which has entered into an agreement to provide pharmaceutical services to participants in the benefit program. A retail Participating Pharmacy may or may not be a select Participating Pharmacy as that term is used in the Vaccinations Obtained Through Participating Pharmacies section.

  • Additional Cardholder means the person you have authorised to use a prepaid card connected to your account, who you agree is authorised to undertake transactions on your behalf and who is also subject to these terms and conditions

  • Provider election officer means an election officer who enters into a contract or

  • Service Level Agreement (SLA) means the Contractual Commitment that prevails between the Buyer and the Service Provider with regard to type of service to be provided, deliverables, desired performance level, reliability and responsiveness, monitoring process and service level reporting, response and issue resolution time-frame, repercussions / penalties / remedies for service provider not meeting its commitment. The SLA of a particular contract may carry the matrix regarding the delivery of the goods and/or services and the corresponding penalties or remedies and liquidated damages as applicable.

  • payment initiation service means a service to initiate a payment order at the request of the payment service user with respect to a payment account held at another payment service provider;

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

  • Participating Home Infusion Therapy Provider means a Home Infusion Therapy 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.