Treating provider definition

Treating provider means a health care provider who has personally evaluated the patient.
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Treating provider means an individual provider who personally renders Medicaid services, or assumes responsibility for rendering Medicaid services through personal supervision, on behalf of a Medicaid group provider. Services furnished by a treating provider are billed by and payment is remitted to the group provider.
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Treating provider means a health care provider who has
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Examples of Treating provider in a sentence

  • Treating provider must submit documentation indicating why it would be clinically inappropriate to require the member to meet this criterion and why this requirement should be waived.

  • Treating provider completes the “Non-Contracted Provider Credentialing Application” so the encounter can be submitted to the Oregon Health Authority (OHA).

  • Provides valid treating Provider information in the submitted encounter data for listed procedure codes, as required in the most recent version of the STATE document titled, “2011 NPI Treating Provider, NPI Pay-To Provider, PCA Treating provider UMPI/NPI, Lead Screening and ED Utilization Managed Care Withhold Technical Specifications.” If the percentage is 95% or greater, the MCO will receive all ten (10) points.

  • Treating provider will have established, over-time, a relationship with and knowledge of the individual’s disability.

  • Treating provider: A person licensed to practice one or more of the following professions: Medicine and surgery, osteopathic medicine and surgery, chiropractic naturopathic physician, podiatry, dentistry, optometry, advanced regis- tered nurse practitioner (ARNP), mental health therapists, and certified medical physician assistants or osteopathic phy- sician assistants.

  • Treating provider submits a claim to the DCO within 12 months of the date of service.

  • Provides valid treating Provider information in the submitted encounter data for listed procedure codes, as required in the most recent version of the STATE document titled, “2010 NPI Treating Provider, NPI Pay-To Provider, PCA Treating provider UMPI/NPI and Lead Screening Managed Care Withhold Technical Specifications.” If the percentage is 95% or greater, the MCO will receive all ten (10) points.

  • Common pieces of information applicable to specific portion(s) of a Claim:• Treating provider information• Referral and / or prescriber information 3.

  • Treating provider means a physician or other health care provider who has evaluated the individual.

  • Section 13410 of the HITECH ActUnsecured record, and modify the definitions of Informant, Part 2 program director, Patient, Program, Records, Third-party payer, Treating provider relationship, and Qualified service organization.(6) § 2.12—Applicability.Replace ‘‘Armed Forces’’ with ‘‘Uniformed Services’’ in paragraph (c)(2) of § 2.12.


More Definitions of Treating provider

Treating provider means a covered person's treating health care provider or a facility at which a covered person is receiving treatment, that is removed from or leaves a health carrier's network pursuant to subdivision (1) of this subsection.
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Treating provider means a health care provider who has evaluated the individual.
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Treating provider means a covered person’s treating health care provider or a facility at which a covered person is receiving treatment, that is removed from or leaves a health carrier’s network. Prohibition of Certain Contract Terms (C.G.S.A. § 38a-477f; C.G.S.A. § 38a-472h) This Agreement shall not contain a provision prohibiting disclosure of (1) billed or allowed amounts, reimbursement rates or out-of- pocket costs, or (2) any data to the all-payer claims database program established under applicable law (19a-755a). Such information may be used to assist consumers and institutional purchasers in making informed decisions regarding their health care and informed choices among health care providers and allow comparisons between prices paid by various health carriers to health care providers. Hold Harmless (C.G.S.A. § 38a-477g) Provider agrees that in no event, including, but not limited to, nonpayment by the health carrier or intermediary, the insolvency of the health carrier or intermediary, or a breach of this Agreement, shall the provider xxxx, charge, collect a deposit from, seek compensation, remuneration or reimbursement from, or have any recourse against a covered person or a person (other than the health carrier or intermediary) acting on behalf of the covered person for services provided pursuant to this Agreement. This Agreement does not prohibit the provider from collecting coinsurance, deductibles or copayments, as specifically provided in the evidence of coverage, or fees for uncovered services delivered on a fee-for-service basis to covered persons. Nor does this Agreement prohibit a provider (except for a health care provider who is employed full-time on the staff of a health carrier and has agreed to provide services exclusively to that health carrier’s covered persons and no others) and a covered person from agreeing to continue services solely at the expense of the covered person, as long as the provider has clearly informed the covered person that the health carrier does not cover or continue to cover a specific service or services. Except as provided herein, this Agreement does not prohibit the provider from pursuing any available legal remedy. Insolvency or Cessation of Operations (C.G.S.A. § 38a-477g) In the event of a health carrier or intermediary insolvency or other cessation of operations, the participating provider’s obligation to deliver covered health care services to covered persons without requesting payment from a covered person other than ...
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Treating provider means the physician or licensed clinician who is providing the direct care to the Covered Person.
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Treating provider means a health care provider who has personally evaluated the patient. 24 Basic Health 2008 Member Handbook Table of Contents Appendix A: Schedule of Benefits “Health outcomes” are results that affect health status as measured by the length or quality (primarily as perceived by the patient) of a person’s life. An intervention is considered to be new if it is not yet in widespread use for the medical condition and patient indications being considered. “New interventions” for which clinical trials have not been conducted because of epidemiological reasons (i.e., rare or new diseases or orphan populations) shall be evaluated on the basis of professional standards of care or expert opinion (see “existing interventions” below). “Scientific evidence” consists primarily of controlled clinical trials that either directly or indirectly demonstrate the effect of the intervention on health outcomes. If controlled clinical trials are not available, observational studies that demonstrate a causal relationship between the intervention and health outcomes can be used. Partially controlled observational studies and uncontrolled clinical series may be suggestive, but do not by themselves demonstrate a causal relationship unless the magnitude of the effect observed exceeds anything that could be explained either by the natural history of the medical condition or potential experimental biases. For “existing interventions,” the scientific evidence should be considered first and, to the greatest extent possible, should be the basis for determinations of “medical necessity.” If no scientific evidence is available, professional standards of care should be considered. If professional standards of care do not exist, or are outdated or contradictory, decisions about existing interventions should be based on expert opinion. Giving priority to scientific evidence does not mean that coverage of existing interventions should be denied in the absence of conclusive scientific evidence. Existing interventions can meet the Basic Health definition of “medical necessity” in the absence of scientific evidence if there is a strong conviction of effectiveness and benefit expressed through up-to-date and consistent professional standards of care or, in the absence of such standards, convincing expert opinion. A level of service, supply, or intervention is considered “cost effective” if the benefits and xxxxx relative to costs represent an economically efficient use of resources for patients with...
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Treating provider means a physician or other health care provider who has evaluated the individual.
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Related to Treating provider

  • 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.

  • 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;

  • 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.

  • 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.

  • Non-Administrator Provider means a Provider that does not meet the definition of Administrator Provider unless otherwise specified in the definition of a particular Provider.

  • 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.

  • Provider is any individual or company that provides professional or technical services.

  • Basic generation service provider or "provider" means a

  • Participating Prosthetic Provider means a Prosthetic 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.

  • 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.

  • Non-Participating Provider means an Administrator Hospital or Professional Provider which does not have 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 a facility which has not been designated by the Claim Administrator as a Participating Provider.

  • Local Service Provider (LSP means the LEC that provides retail local Exchange Service to an End User. The LSP may or may not provide any physical network components to support the provision of that End User’s service.

  • Replacement Service Provider means any third party service provider appointed to perform the Services by the Purchaser from time to time.

  • Local Service Provider (LSP) is the LEC that provides retail local Exchange Service to an End User. The LSP may or may not provide any physical network components to support the provision of that End User’s service.

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

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other entity administering the Medicaid program and a health care operation under which the health care operation agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

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

  • Approved provider means a provider of services registered with the appropriate association or organization to render services to a member and approved by Latrobe to render services to its members.

  • Ambulance service provider means Latrobe Health Services recognises the following providers for the purposes of paying benefits:

  • Preferred Provider or “Network Provider” means a doctor, hospital, medical facility or other provider of health care which is included in a network which has been designated by the Fund to render health related services to Fund participants.

  • Plan Provider means a Provider which has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered to you.

  • Preferred Provider Organization or "PPO" means an entity through which a group of health care providers, such as doctors, hospitals and others, agree to provide specific medical and hospital care and some related services at a negotiated price.

  • 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.

  • 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.

  • 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.