Non-Participating Provider. A Provider that does not have a Provider Agreement with Xxxxx Vision pertaining to payment for Covered Services rendered to a Member. This Provider may also be referred to as a "Non- Network” or “Out-of-Network” Provider. Provider Agreement – An agreement for payment contracted by Xxxxx Vision with Participating Providers. These agreements establish the actual payments which will be made to the Participating Provider. The payments may reflect a discount or payment formula that has been contracted between Xxxxx Vision and the Participating Provider.
Non-Participating Provider. A Provider that does not have a Provider Agreement with United Concordia Dental pertaining to payment for Covered Services rendered to a Member. Provider Agreement – An agreement for payment contracted by Claims Administrator with Participating Providers. These agreements establish the actual payments which will be made to the Participating Provider. The payments may reflect a discount or payment formula that has been contracted between Claims Administrator and the Participating Provider. Rescission of Coverage – Cancellation or discontinuance of coverage that has retroactive effect. Sealant – Plastic material usually applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most often, so that they act as a barrier to prevent cavities. Space Maintainer – Besides being useful for chewing, baby teeth also act as a guide for the eruption of the permanent teeth that replaces them. If a baby’s tooth is lost too early, the permanent tooth that comes after it loses its guide, so it could drift or erupt into the wrong position in the mouth. Neighboring teeth also can move or tilt into the space, reducing the space available for the permanent tooth to come out. Space maintainers are appliances used when a baby tooth is lost too early to help make room for the permanent tooth it was intended to guide. Special Enrollment Period – The sixty (60) day period of time during which a Subscriber and eligible Dependents may enroll or disenroll from coverage under this Contract. Spouse – The Subscriber’s legal Spouse. Subscriber – An Eligible Person who has satisfied the specifications of this Contract's Schedule of Eligibility and has enrolled for coverage, and to whom the Company has issued a copy of this Contract. Temporomandibular/Craniomandibular Joint Disorder – Disorders resulting in pain and/or dysfunction of the temporomandibular/craniomandibular joint which arise out of rheumatic disease, dental occlusive disorders, internal or external joint stress, or other causes. Waiting Period – A period of time a Member must be enrolled under this Contract before benefits will be paid for certain Covered Services as shown on the Schedule of Dental Benefits.
Non-Participating Provider. Non-participating provider is a provider (doctor, hospital, pharmacy, etc.) that does not sign a contract to participate in the Contractor’s provider network.
Non-Participating Provider. A Provider that does not have a Provider Agreement with United Concordia Dental pertaining to payment for Covered Services rendered to a Member. Provider Agreement – An agreement for payment contracted by Claims Administrator with Participating Providers. These agreements establish the actual payments which will be made to the Participating Provider. The payments may reflect a discount or payment formula that has been contracted between Claims Administrator and the Participating Provider. Sealant – Plastic material usually applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most often, so that they act as a barrier to prevent cavities.
Non-Participating Provider. Our practice is pleased to work with you as you navigate the complexity of health insurance. We will do our best to answer your questions and are available to help you sort through health insurance plans as you evaluate what works best for you and your family. However, if your health insurance does not participate with PPC Atlanta we may be unable to file your insurance claims using these carriers. Under such circumstance you will be responsible for a standard office visit charge of $50. We will attempt to submit to your insurance carrier for the balance of our office visit charge and will write off any remaining patient balance this office visit fee. However, patients will be responsible for non-covered immunizations and laboratory fees, which we will attempt to submit to insurance for out of network reimbursement on your behalf. In addition, PPC will attempt to use in network laboratories to minimize your out of pocket costs. A list of health plans that PPC Atlanta participates with will be available on our website. However, patients are encouraged to confirm participation prior to enrollment.
Non-Participating Provider. If You have insurance with which the Practice and/or its physicians do not participate, the Practice will file a claim with your insurance company as a courtesy only with respect to covered services that are provided. Under such circumstances, You will be responsible for an office visit charge.
Non-Participating Provider. A Provider that does not have a Provider Agreement with United Concordia Dental pertaining to payment for Covered Services rendered to a Member. Provider Agreement – An agreement for payment contracted by Claims Administrator with Participating Providers. These agreements establish the actual payments which will be made to the Participating Provider. The payments may reflect a discount or payment formula that has been contracted between Claims Administrator and the Participating Provider. Rescission of Coverage – Cancellation or discontinuance of coverage that has retroactive effect. Sealant – Plastic material usually applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most often, so that they act as a barrier to prevent cavities.
Non-Participating Provider. Non-Par or non-participating Providers are Primary Care Providers that have not entered into an agreement with PCCM entity and are not part of the PCP Network, unlike participating Providers
Non-Participating Provider. A person or entity eligible to provide Medicaid services that does not have a contractual agreement with the Managed Care Plan to provide services. In order to receive payment for covered services, non-participating providers must be eligible for a Medicaid provider agreement and recognized in the Medicaid system (FMMIS) as either actively enrolled Medicaid providers or as Managed Care Plan registered providers.
Non-Participating Provider. A person or entity eligible to provide Medicaid services and that does not have a contractual agreement with a Health Plan to provide services. In order to receive payment for covered services, PSN fee-for-service non-participating providers must have an active Medicaid provider agreement. All other Health Plan non-participating providers must be eligible for a Medicaid provider agreement and recognized in the Medicaid system (FMMIS) as either actively enrolled Medicaid providers or as Health Plan registered providers.
