Affiliated provider definition

Affiliated provider means a health professional, licensed hospital, licensed pharmacy, or any other institution, organization, or person that has entered into a participating provider contract, directly or indirectly, with a health maintenance organization to render 1 or more health services to an enrollee. Affiliated provider includes a person described in this subdivision that has entered into a written arrangement with another person, including, but not limited to, a physician hospital organization or physician organization, that contracts directly with a health maintenance organization.
Affiliated provider means a health professional, a Hospital, licensed pharmacy, or any other institution, organization, or person who has a contract with the Plan or an IPA to render one (1) or more health maintenance services to Members.
Affiliated provider means any provider that is employed by or has entered into a contractual

Examples of Affiliated provider in a sentence

  • Affiliated provider includes a person described in this subdivision that has entered into a written arrangement with another person, including, but not limited to, a physician hospital organization or physician organization, that contracts directly with a health maintenance organization.


More Definitions of Affiliated provider

Affiliated provider means a health professional, a Hospital, licensed pharmacy, or any other institution, or person who has a contract with the Plan.
Affiliated provider means a provider that is: (A) Employed by a hospital or health system, (B) under a professional services agreement with a hospital or health system that permits such hospital or health system to bill on behalf of such provider, or (C) a clinical faculty member of a medical school, as defined in section 33-182aa, that is affiliated with a hospital or health system in a manner that permits such hospital or health system to bill on behalf of such clinical faculty member;
Affiliated provider means a provider that is: (a) employed by a
Affiliated provider means a pharmacy or durable medical equipment provider that directly, or indirectly through one or more intermediaries, controls, is controlled by, or is under common control with a health benefit plan issuer or pharmacy benefit manager.
Affiliated provider means any provider that is employed by or has entered into a contractual 1272 agreement either directly or indirectly with a health carrier to provide health care services to members 1273 of a managed care health insurance plan for which the health carrier is responsible under this chapter. 1274 "Basic health care services" means emergency services, inpatient hospital and physician care, 1275 outpatient medical services, laboratory and radiological services, and preventive health services. "Basic 1276 health care services" shall also mean limited treatment of mental illness and substance abuse as set 1277 forth in § 38.2-3412.1 or in the case of a health maintenance organization shall be in accordance with 1278 such minimum standards set by the Commission which shall not exceed the level of services mandated 1279 for insurance carriers pursuant to Chapter 34 (§ 38.2-3400 et seq.).
Affiliated provider means a [certified]licensed EMS individual's secondary employer or employers.
Affiliated provider means a legally separate provider that is the parent organization of the provider, is under common ownership, management or control with the provider, or is owned, managed, or controlled by the provider.