PROVIDER PARTICIPATION AGREEMENTProvider Participation Agreement • February 14th, 2020
The purpose of this agreement is to allow participation in the Ground Emergency Medical Transportation (GEMT) Uncompensated Cost Reimbursement Program by the governmentally owned or operated provider, named above and hereinafter referred to as Provider, subject to the provider’s compliance with the requirements and responsibilities set forth in this agreement.
PROVIDER PARTICIPATION AGREEMENT Please review, sign page 5 and return to Laura Locicero at fax (516) 465-8002, or send a signed, scanned document to ciipa@nshs.edu.Provider Participation Agreement • September 17th, 2020 • New York
THIS AGREEMENT, made by and between North Shore-LIJ Network, Inc. and its related IPA, North Shore-LIJ Clinical Integration Network IPA, LLC (the entities collectively shall be referred to as the “CIIPA”), and ___________________________________ (“Provider”) a Provider licensed to practice ________________________________ in the State of New York with an address at _________________________________, _______________________ is effective as of the date of its execution by CIIPA (“Effective Date”). This Agreement sets forth the terms under which Provider agrees to participate in CIIPA.
PROVIDER PARTICIPATION AGREEMENTProvider Participation Agreement • September 13th, 2019
The purpose of this Agreement is to allow participation in the Ground Emergency Medical Transportation Supplemental Reimbursement Program (GEMT program) by the governmentally owned or operated provider, named above and hereinafter referred to as Provider, subject to Provider’s compliance with the responsibilities set forth in this Agreement with the California Department of Health Care Services (DHCS), hereinafter referred to as the State or DHCS, as authorized in State law pursuant to section 14105.94 of the California Welfare and Institutions Code.
Provider Participation AgreementProvider Participation Agreement • January 25th, 2022 • Colorado
This Provider Participation Agreement (“Agreement”) is entered into by and between the Colorado Department of Health Care Policy and Financing (“Department”), its Fiscal Agent for the Colorado Medical Assistance Program, and Provider (“Provider”),
Provider Participation Amendment betweenProvider Participation Agreement • October 20th, 2017
THIS AMENDMENT to the Provider Participation Agreement (“Agreement”) entered into on November 1, 2017 by and between Nevada Health Partners (“Coalition”) and Carson Tahoe Health System (“CTHS”) is made and entered into effective January 1, 2018.
Appendix IProvider Participation Agreement • May 31st, 2022
Note: All those providers with a current Health First Colorado Provider ID number, or those providers submitting an application to become a Health First Colorado Provider MUST REVIEW AND ACCEPT the Provider Participation Agreement as part of the Online Enrollment process.
PROVIDER PARTICIPATION AGREEMENTProvider Participation Agreement • February 14th, 2020
The purpose of this Agreement is to allow participation in the Ground Emergency Medical Transportation (GEMT) Uncompensated Cost Reimbursement Program by the governmentally owned or operated provider, named above and hereinafter referred to as Provider, subject to the Provider’s compliance with the requirements and responsibilities set forth in this Agreement.
PROVIDER PARTICIPATION AGREEMENTProvider Participation Agreement • January 28th, 2015
Ancillary Provider Participation AgreementProvider Participation Agreement • December 19th, 2022
This Agreement is entered into by and between UnitedHealthcare Insurance Company, contracting on behalf of itself, UnitedHealthcare of Ohio, Inc., UnitedHealthcare Community Plan of Ohio, Inc. and the other entities that are United’s Affiliates (collectively referred to as “United”) and (“Facility”).
PROVIDER PARTICIPATION AGREEMENT Between ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ADMINISTRATION (AHCCCSA) andProvider Participation Agreement • October 19th, 2007 • Ensign Group, Inc • Services-skilled nursing care facilities
This Agreement between AHCCCSA and the Provider is made pursuant to Title XIX of the Social Security Act and A.R.S. Title 36, Chapter 29 to govern: (1) registration and payment for the health care services provided by the Provider to eligible persons who are not enrolled with a program contractor or health plan under contract with AHCCCSA ("Contractors") or who receive emergency services ("fee-for-service patients"), and (2) registration for the Provider to participate in the Arizona Health Care Cost Containment System through a Contractor.
Ancillary Provider Participation AgreementProvider Participation Agreement • August 1st, 2020
This Agreement is entered into by and between UnitedHealthcare Insurance Company, contracting on behalf of itself, Arizona Physicians IPA, Inc., and the other entities that are United’s Affiliates (collectively referred to as “United”) and City of Tempe (“Facility”).
PROVIDER PARTICIPATION AGREEMENTProvider Participation Agreement • March 30th, 2015
The parties agree that this Amendment A updates Provider Participation Agreement (PPA) # 30-1318, dated 09/30/2013 by amending the PPA in its entirety. This Amendment A removes all provisions of the PPA and inserts the following provisions effective on July 1, 2015.
