Delegation of Provider Selection Sample Clauses

Delegation of Provider Selection. As applicable, Provider understands that if selection of providers who render services to Managed Care Plan Enrollees has been delegated to ILS Community Network and/or Provider by Managed Care Plan, either expressly or impliedly, then Managed Care Plan retains the right to approve, suspend or terminate such downstream or subcontracted arrangements. [42 C.F.R. § 422.504 (i) (5).]

Delegation of Provider Selection. As applicable, Provider understands that if selection of providers who render services to Medicare beneficiaries has been delegated to First Tier Entity by Health Plan, either expressly or impliedly, then Health Plan retains the right to approve, suspend or terminate such downstream or subcontracted arrangements to the extent applicable to Medicare beneficiaries enrolled with Health Plan. [42 C.F .R. § 422.504(i)( 5).]

Delegation of Provider Selection. Where applicable, in instances where practitioner selects providers related to the rendering of care to Group Health Cooperative managed care members, Group Health Cooperative retains the right to approve, suspend, or terminate such arrangement as required under 422.504(i)(5).

Delegation of Provider Selection. In addition to the responsibilities for delegated activities as set forth herein, to the extent that Plan has delegated selection of providers, contractors, or subcontractor to Provider, Plan retains the right to approve, suspend, or terminate any such arrangement.

Delegation of Provider Selection. In addition to the responsibilities as set forth in section 12.4 above, to the extent that Plan has delegated selection of the providers, contractors, or subcontractor to Provider, the Plan retains the right to approve, suspend, or terminate any such arrangement. WORKERS' COMPENSATION PARTICIPATION ATTACHMENT TO THE ANTHEM BLUE CROSS AND BLUE SHIELD PROVIDER AGREEMENT This is a Participation Attachment to the Anthem Blue Cross Provider Agreement ("Agreement"), entered into by and between Anthem and Provider and is incorporated into the Agreement.

Delegation of Provider Selection. Where applicable, in instances where practitioner selects providers related to the rendering of care to KFHPWA managed care members, KFHPWA retains the right to approve, suspend, or terminate such arrangement as required under 422.504(i)(5).

Delegation of Provider Selection. In addition to the responsibilities as set forth in section 12.4 above, to the extent that Plan has delegated selection of the providers, contractors, or subcontractor to Provider, the Plan retains the right to approve, suspend, or terminate any such arrangement. HEALTH CARE PROVIDER SUMMARY DISCLOSURE FORM Anthem Blue Cross and Blue Shield (Anthem) HMO Colorado, Inc. (HMOC) Provider Name: Board of Commissioner of Ouray County on behalf of its Public Health Agency TIN: 00-0000000 Date: May 28, 2015 I. Compensation and Payment  Fee for Service  Reimbursement: Indemnity: The lesser of billed charges or 100% of the Medicare RBRVS fee schedule. PPO: The lesser of billed charges or 100 % of the Medicare RBRVS fee schedule. HMO: The lesser of billed charges or 100% of the Medicare RBRVS fee schedule. Medicare Advantage: 100% of the current Medicare fee schedule % of the current Medicare fee schedule  For information on the Medicare RBRVS Physician fee schedule, please visit xxxx://xxx.xxx.xxx.xxx/PhysicianFeeSched/. NPs and PAs: Anthem shall reimburse NP/PA Provider the lesser of billed charges or 100% of the Medicare RBRVS fee schedule Anthem BCBS has implemented for Covered Services  Beginning July 1, 2015, Anthem’s physician fee schedule is based on the January 2014 Medicare fee schedule. Anthem applies the Colorado Geographic Practice Cost Indexes (GPCIs) to the RVUs and utilizes Site of Service differentials. The Medicare conversion factor that Anthem is using for 2014 is 35.82 instead of 35.8228. The Medicare RVUs are rounded from four (4) decimal points to two (2) decimal points. ● For information on the Medicare fee schedule, please visit xxxx://xxx.xxx.xxx.xxx/PhysicianFeeSched/. ● Immunizations are paid 100% of AWP (Average Wholesale Price); Non-Immunizations with a CMS XXX, 000% of ASP; as of 01/01/10: Non-Immunizations with no CMS ASP, 85% of AWP. A flat fee table for ASP (Average Sell Price) Drugs, updated from time to time, is available at the CMS website at: xxxx://xxx.xxx.xxx.xxx/McrPartBDrugAvgSalesPrice/. Anthem uses XxxxxxxxxxxxxXxxxx.xxx for AWP. The following services’ reimbursement rates are located in Plan Compensation Schedule Attachment – of your contract. ● DME and supplies ● Lab services/codes done in the office ● Therapy Codes (97001-97799) ● Radiology codes ● Sleep Studies (in-office) ● Allergy Immunotherapy : CPT code 95165 ● Non-Invasive Vascular Diagnostic Studies: CPT Codes 93880 – 93990 ● Allergy Testing: CPT Codes 95004 – 9...