Selective contracting arrangement definition

Selective contracting arrangement means an arrangement in which a health maintenance organization participates in selective contracting with one or more providers, and which arrangement contains reasonable benefit differentials, including, but not limited to, predetermined fee or reimbursement rates for covered benefits applicable to participating and nonparticipating providers.
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Selective contracting arrangement means an arrangement in
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Selective contracting arrangement means an arrangement in which a benefits payer participates in selective contracting with one or more participating health care providers or organized delivery systems, and which arrangement contains reasonable benefit differentials, including, but not limited to, predetermined fee or reimbursement rates for covered services applicable to participating and nonparticipating health care providers and organized delivery systems.
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Examples of Selective contracting arrangement in a sentence

  • He explained that this can be budgeted; however, certain rules apply through the Federal Governments equitable sharing program, and funds can only be used for certain things.

  • The law leaves those issues for the Commissioner to address in regulations adopted to administer and enforce the law consistent with the stated goals— "health care cost containment and preserv[ation] of quality care." N.J.S.A. 17B:27A-54.N.J.A.C. 11:22-5.2 provides that "'Selective contracting arrangement contract' .


More Definitions of Selective contracting arrangement

Selective contracting arrangement means an agreement for the
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Selective contracting arrangement or "SCA" means an arrangement for the payment of predetermined fees or reimbursement levels for covered services by the carrier to [preferred] network providers, [or preferred provider organizations] HMOs, certified ODSs, licensed
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Selective contracting arrangement means an arrangement for the
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Related to Selective contracting arrangement

  • netting arrangement means an arrangement under which a number of claims or obligations can be converted into a single net claim, including close-out netting arrangements under which, on the occurrence of an enforcement event (however or wherever defined) the obligations of the parties are accelerated so as to become immediately due or are terminated, and in either case are converted into or replaced by a single net claim, including ‘close-out netting provisions’ as defined in point (n)(i) of Article 2(1) of Directive 2002/47/EC and ‘netting’ as defined in point (k) of Article 2 of Directive 98/26/EC;

  • Collective Agreement means a written agreement concerning terms and conditions of employment or any other matter of mutual interest concluded by one or more registered trade unions, on the one hand and, on the other hand-

  • 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.

  • Prospective contractor means a person who is subject to the competitive sealed proposal process set forth in the Procurement Code or is not required to submit a competitive sealed proposal because that person qualifies for a sole source or a small purchase contract.

  • Sub-contracting means the primary contractor’s assigning or leasing or making out work to, or employing another person to support such primary contractor in the execution of part of a project in terms of the contract.