Non-Contracted Providers Sample Clauses

Non-Contracted Providers. For both physician/professional and institutional claims incurred in other plan service areas with non-contracted providers, no Access Fee applies. The AEA fee for non-contracted provider claims will be $3.00 per claim unless an alternative fee arrangement was negotiated with the Host Blue plan. If PCPM fees have been negotiated with Host Blue plans, there will be no additional AEA fee for processing claims from non-contracted providers outside of BCBSNE’s service area. If Non-Standard AEA fees have been negotiated with Host Blue plans, such fees will also apply to claims processed from non-contracted healthcare providers outside of BCBSNE’s service area.
Sample 1
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Non-Contracted Providers. The CONTRACTOR shall: If the CONTRACTOR’s network is unable to provide Medically Necessary Core Benefits to a particular Member the CONTRACTOR shall adequately cover these services. The CONTRACTOR must inform the Non-Contracted Provider that that the Member cannot be balance billed. The CONTRACTOR shall coordinate with Non-Contracted Providers regarding payment for services. For payment to Non-Contracted Providers the following guidelines apply: If the CONTRACTOR offers the service through a Subcontracted Provider and the Member chooses to access the service from a Non-Contracted Provider, the CONTRACTOR is not responsible for payment. If the service is not available from a Subcontracted Provider and the Member requires the service and is referred for treatment to a Non-Contracted Provider reimbursement is determined by the CONTRACTOR and Non-Contracted Provider. If the service is not available from a Subcontracted Provider, but the CONTRACTOR has three (3) documented attempts to contract with a non-contracted Provider, the CONTRACTOR may reimburse that Provider less than the Medicaid Fee for Service rate. If the service is available from a Subcontracted Provider, but the service meets the level of emergency services and the CONTRACTOR has three (3) documented attempts to contract with the Provider, the CONTRACTOR may reimburse less than the Medicaid Fee for Service rate.
Sample 1

Related to Non-Contracted Providers

  • Excluded Providers 6.4.1 Definition of Excluded Providers In accordance with 42 CFR 438.214(d), the Contractor may not employ or contract with Providers who are Excluded from participation in Federal Health Care Programs under either Section 1128 or 1128(A) of the Social Security Act.

  • Agreements with Subcontractors Business Associate shall enter into a Business Associate Agreement with any Subcontractor to whom it provides PHI received from Covered Entity or created or received by Business Associate on behalf of Covered Entity in which the Subcontractor agrees to the same restrictions and conditions that apply through this Agreement to Business Associate with respect to such PHI. Business Associate must enter into this Business Associate Agreement before any use by or disclosure of PHI to such agent. The written agreement must identify Covered Entity as a direct and intended third party beneficiary with the right to enforce any breach of the agreement concerning the use or disclosure of PHI. Business Associate shall provide a copy of the Business Associate Agreement it enters into with a subcontractor to Covered Entity upon request. Business associate may not make any disclosure of PHI to any Subcontractor without prior written consent of Covered Entity.

  • Contracts With Service Providers 13 Section 1.

  • Engineer Payment of Subproviders No later than ten (10) days after receiving payment from the State, the Engineer shall pay all subproviders for work performed under a subcontract authorized hereunder. The State may withhold all payments that have or may become due if the Engineer fails to comply with the ten-day payment requirement. The State may also suspend the work under this contract or any work authorization until subproviders are paid. This requirement also applies to all lower tier subproviders, and this provision must be incorporated into all subcontracts.

  • Contracts with Subcontractors a. Grantee may enter into contracts with subcontractors unless restricted or otherwise prohibited in the Contract.

  • Conflict of Interest Contractor Personnel 2.5.1 The A-E shall exercise reasonable care and diligence to prevent any actions or conditions that could result in a conflict with the best interests of the COUNTY. This obligation shall apply to the A-E; the A-E’s employees, agents, and relatives; sub-tier contractors; and third parties associated with accomplishing work and PROJECTS/SERVICES hereunder.

  • Management Services Agreement The term "Management Services ----------------------------- Agreement" shall mean this Management Services Agreement by and between Practice and Business Manager and any amendments hereto.

  • Master Services Agreement This Agreement is a master agreement governing the relationship between the Parties solely with regard to State Street’s provision of Services to each BTC Recipient under the applicable Service Modules.

  • CONTRACTS WITH ELIGIBLE FOREIGN CUSTODIANS The Foreign Custody Manager shall determine that the contract governing the foreign custody arrangements with each Eligible Foreign Custodian selected by the Foreign Custody Manager will satisfy the requirements of Rule 17f-5(c)(2).

  • Participating Providers To find out if a Provider is a Participating Provider: • Check Our Provider directory, available at Your request; • Call the number on Your ID card; or • Visit our website at xxx.xxxxxx.xxx. The Provider directory will give You the following information about Our Participating Providers: • Name, address, and telephone number; • Specialty; • Board certification (if applicable); • Languages spoken; and • Whether the Participating Provider is accepting new patients.

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