MA PPO Program Clause Samples
The "MA PPO Program" clause defines the terms and conditions under which a Medicare Advantage Preferred Provider Organization (PPO) health plan operates within the agreement. This clause typically outlines the scope of covered services, the network of participating providers, and the obligations of both the insurer and the providers regarding patient care and reimbursement. For example, it may specify how members can access out-of-network care or detail the process for provider credentialing. The core function of this clause is to establish clear operational guidelines for the administration of the MA PPO plan, ensuring that all parties understand their roles and responsibilities in delivering healthcare services to plan members.
MA PPO Program. A program to provide and pay for Covered Services to Members under an MA PPO Benefit Contract and its contract with CMS, authorized under Title XVIII, of the Social Security Act, as amended (otherwise known as Medicare).