Common use of Participating Provider Clause in Contracts

Participating Provider. A CHAMPUS- authorized provider that is required, or has agreed by entering into a CHAMPUS participation agreement or by act of indicating ‘‘accept assign- ment’’ on the claim form, to accept the CHAMPUS-allowable amount as the maximum total charge for a service or item rendered to a CHAMPUS bene- ficiary, whether the amount is paid for fully by CHAMPUS or requires cost- sharing by the CHAMPUS beneficiary. Part-time or intermittent home health aide and skilled nursing services. Part- time or intermittent means skilled nursing and home health aide services furnished any number of days per week as long as they are furnished (com- bined) less than 8 hours each day and 28 or fewer hours each week (or, subject to review on a case-bay-case basis as to the need for care, less than 8 hours each day and 35 or fewer hours per week). Party to a hearing. An appealing party or parties and CHAMPUS. Party to the initial determination. In- cludes CHAMPUS and also refers to a CHAMPUS beneficiary and a partici- pating provider of services whose inter- ests have been adjudicated by the ini- tial determination. In addition, a pro- vider who has been denied approval as an authorized CHAMPUS provider is a party to that initial determination, as is a provider who is disqualified or ex- cluded as an authorized provider under CHAMPUS, unless the provider is ex- cluded based on a determination of abuse or fraudulent practices or proce- dures under another federal or xxxxx- ally funded program. See § 199.10 for ad- ditional information concerning par- ties not entitled to administrative re- view under the CHAMPUS appeals and hearing procedures.