Applicable Payor definition

Applicable Payor has the meaning set forth in Section 5.04(a) of the Participation Agreement.
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Applicable Payor has the meaning given to it in Section6.4.
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Applicable Payor is defined in Section 3.1.
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Examples of Applicable Payor in a sentence

  • Dentist agrees to render all necessary dental services to each of the Subscribers covered by the Applicable Payor during Dentist’s regular office hours, subject to prior appointments; provided, however, that Dentist shall have the right within the framework of professional ethics to reject any patient seeking Dentist’s professional services.

  • It is expressly agreed between the Parties that Dentist is an independent contractor and that neither Subscriber nor Applicable Payor shall have any dominion or control over Dentist’s practice, the Dentist-Patient relationship, Dentist’s personnel or facilities.

  • Plan and Applicable Payor shall not be liable for any act or omission by Dentist.

  • Subscribers (defined herein) and/or groups have entered into contracts with Applicable Payor to arrange for certain professional services including dental services.

  • Dentist agrees to charge Applicable Payor as payment in full for services rendered under the scope of this Agreement no more than the amounts set forth in the attached fee schedule, which is attached hereto as Exhibit C and made a part of this Agreement hereof.

  • Dentist shall look solely to Applicable Payor (or Subscriber under discounted fee-for-service programs) for compensation and shall not seek compensation from Subscribers, except for applicable cost sharing amounts or services not covered under the applicable dental benefit.

  • Dentist shall maintain the Dentist-Patient relationship with Subscribers of the Applicable Payor, and shall be solely responsible to the patient for dental advice and treatment.

  • Plan is entering into this Agreement with Dentist who will provide dental services and who will bill Applicable Payor (or Subscriber under discounted fee-for-service programs) according to a fee schedule established by Plan.

  • Plan is entering into this Agreement with Dentist who will provide dental services and who will xxxx Applicable Payor (or Subscriber under discounted fee-for-service programs) according to a fee schedule established by Plan.

  • If the Applicable Payor shall so deduct or withhold any such Taxes, it shall provide a statement to the Applicable Payee setting forth the amount of such Taxes as deducted or withheld, the applicable rate and any other information or documentation which such Person may reasonably request for enabling such Person to obtain any allowable credits or deductions for the Taxes so deducted or withheld in the jurisdiction or jurisdictions in which such Person is subject to Taxes.


More Definitions of Applicable Payor

Applicable Payor shall have the meaning set forth in, as applicable, Section 12.3(a) or 13.3(a).
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Applicable Payor shall have the meaning set forth in Section 11.05(b)(1) hereof.
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Applicable Payor has the meaning specified in Section 2.12.
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Applicable Payor is defined in Section 13.13 of the Participation Agreement.
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Related to Applicable Payor

  • Applicable Party means (1) all corporate officers of the Disclosing Party, if the Disclosing Party is a corporation; all partners of the Disclosing Party, if the Disclosing Party is a general partnership; all general partners and limited partners of the Disclosing Party, if the Disclosing Party is a limited partnership; all managers, managing members and members of the Disclosing Party, if the Disclosing Party is a limited liability company; (2) all principal officers of the Disclosing Party; and (3) any person having more than a 7.5 percent ownership interest in the Disclosing Party. "Principal officers" means the president, chief operating officer, executive director, chief financial officer, treasurer or secretary of a legal entity or any person exercising similar authority.

  • Medicare eligible expenses means expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.

  • Applicable Wages means the basic straight time wages for all hours worked, including:

  • Third Party Payor means Medicare, Medicaid, TRICARE, and other state or federal health care program, Blue Cross and/or Blue Shield, private insurers, managed care plans and any other Person or entity which presently or in the future maintains Third Party Payor Programs.

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Restricted Amount has the meaning set forth in Section 2.11(b)(iv).

  • Applicable ECF Percentage means, for any fiscal year, (a) 50% if the Total Leverage Ratio as of the last day of such fiscal year is greater than or equal to 6.00 to 1.00, (b) 25% if the Total Leverage Ratio as of the last day of such fiscal year is less than 6.00 to 1.00 but greater than or equal to 5.00 to 1.00 and (c) 0% if the Total Leverage Ratio as of the last day of such fiscal year is less than 5.00 to 1.00.

  • Simplified and/or aggregate billing arrangement means a billing arrangement providing additional medical gap benefits.

  • Covered Amount means, for any Distribution Date with respect to the Controlled Accumulation Period or the first Special Payment Date, if such Special Payment Date occurs prior to the date the Class A Invested Amount is paid in full, an amount equal to the sum of (x) with respect to the Class A Certificates, the product of (i) the Class A Certificate Rate, (ii) a fraction, the numerator of which is the actual number of days from and including the prior Distribution Date to but excluding the then current Distribution Date and the denominator of which is 360 and, (iii) the Principal Funding Account Balance, if any, as of the preceding Distribution Date that is allocable to the principal of the Class A Certificates and (y) with respect to the Class B Certificates, the product of (i) the Class B Certificate Rate, (ii) a fraction, the numerator of which is the actual number of days from and including the prior Distribution Date to but excluding the then current Distribution Date and the denominator of which is 360 and (iii) the Principal Funding Account Balance, if any, as of the preceding Distribution Date that is allocable to the principal of the Class B Certificates.

  • Non-Participating Certified Nurse-Midwife means a Certified Nurse-Midwife who does not have a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Applicable Parties has the meaning assigned to it in Section 8.03(c).

  • Third Party Payors means Medicare, Medicaid, CHAMPUS, Blue Cross and/or Blue Shield, private insurers and any other Person which presently or in the future maintains Third Party Payor Programs.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Applicable Par Call Date means with respect to the (i) 2028 Notes, June 12, 2028, (ii) 2031 Notes, May 12, 2031, (iii) 2041 Notes, February 12, 2041, (iv) 2051 Notes, February 12, 2051 and (v) 2061 Notes, February 12, 2061.

  • Non-Participating Orthotic Provider means an Orthotic Provider who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Applicable Credit Support Percentage As defined in Section 4.02(e).

  • Third Party Payor Programs means all third party payor programs in which Tenant presently or in the future may participate, including, without limitation, Medicare, Medicaid, CHAMPUS, Blue Cross and/or Blue Shield, Managed Care Plans, other private insurance programs and employee assistance programs.

  • Reduction Percentage means the percentage rate by which the Initial Per Certificate Entitlement will reduce on a daily basis on the assumption that the daily rate will be theper annum rate specified in the Final Terms divided by 365 and applied accordingly. B.26 Investment managementNot applicable - there is no active management of the assets of the Issuer. B.27 Further issuances backed by same pool of assetsNot applicable – the Issuer will not issue further securities backed by the same pool of assets. B.29 Description of the flow of fundsSave to the extent that the Authorised Participant as subscribed for the issue of Certificates in whole or in part by the physical delivery of the relevant Precious Metal in respect of the Series (the "Underlying Precious Metal"), the net proceeds from each issue of Certificates will be used (a) to purchase the Underlying Precious Metal and (b) to pay any listing fees incurred in connection with the listing of the Certificates. The Certificates will not bear interest. On redemption, a Certificateholder will, in respect of a Certificate, receive on a date on or before the third business day following the relevant Eligible Redemption Valuation Date(being any business day) (in each case the "Settlement Date"):

  • Applicable Revolving Percentage means with respect to any Revolving Lender at any time, such Revolving Lender’s Applicable Percentage in respect of the Revolving Facility at such time.

  • Original Applicable Credit Support Percentage With respect to each Class of Subordinate Certificates, the corresponding percentage set forth opposite its Class designation: Class B-1 - 3.10%; Class B-2 - 2.05%; Class B-3 - 1.25%; Class B-4 - 0.80%; Class B-5 - 0.55%; and Class B-6 - 0.35%.

  • Applicable Commitment Percentage means, with respect to each Lender at any time, a fraction, the numerator of which shall be such Lender's Revolving Credit Commitment and the denominator of which shall be the Total Revolving Credit Commitment, which Applicable Commitment Percentage for each Lender as of the Closing Date is as set forth in Exhibit A; provided that the Applicable Commitment Percentage of each Lender shall be increased or decreased to reflect any assignments to or by such Lender effected in accordance with Section 11.1.

  • Concentration Percentage means (i) for any Group A Obligor, 10.00%, (ii) for any Group B Obligor, 8.00%, (iii) for any Group C Obligor, 6.00% and (iv) for any Group D Obligor, 4.00%.

  • Applicable Dollar Percentage means, with respect to any Dollar Lender, the percentage of the total Dollar Commitments represented by such Dollar Lender’s Dollar Commitment. If the Dollar Commitments have terminated or expired, the Applicable Dollar Percentages shall be determined based upon the Dollar Commitments most recently in effect, giving effect to any assignments.

  • Applicable Collateral Percentage with respect to any Firm Collateral or Special Firm Collateral, has the meaning set forth in the books and records of the Partnership with respect thereto.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Non-Participating Certified Nurse Practitioner means a Certified Nurse Practitioner who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.