Delegated Entity means an entity, other than a health maintenance organization authorized to engage in business under Chapter843, that by itself, or through subcontracts with one or more entities, undertakes to arrange for or provide medical care or health care to an enrollee in exchange for a predetermined payment on a prospective basis and that accepts responsibility for performing on behalf of the health maintenance organization a function regulated by this chapter, Chapter 222, 251, or 258, as applicable to a health maintenance organization, Chapter 843 or 1271, Section 1367.053, Subchapter A, Chapter 1452, or Subchapter B, Chapter 1507. The term does not include:
Delegated Entity means any party that enters into an agreement with Plan to provide administrative services or health care services to qualified individuals, qualified employers, or qualified employees and their dependents. Provider is a Delegated Entity.
Delegated Entity means a unit or single organization authorized by written agreement to act on behalf of the insurer to provide managed care services.
Examples of Delegated Entity in a sentence
Licensor shall be liable to Licensee for all acts and omissions of any Delegated Entity in performing any duties hereunder.
In the event SCHA and Delegated Entity are unable to resolve disputes arising as a result of this Agreement, this Agreement shall be modified or terminated pursuant to Section 5.
Under certain circumstances, SCHA may allow Delegated Entity to sub-delegate all or part of the delegated Services under this Agreement to another entity.
SCHA and Delegated Entity agree to work together in good faith to resolve any and all disputes related to this Agreement.
SCHA shall provide a report of its audit findings to Delegated Entity within ninety (90) calendar days of the audit’s conclusion.
More Definitions of Delegated Entity
Delegated Entity means an entity that is not an Affiliate of Company to the extent that such entity (i) maintains its own contracts with Physicians separate from any contracts between Company and Physicians, and, by agreement with Company, (ii) (A) agrees to provide Plan Members with access to such Physicians pursuant to the terms of such agreements; and (B) performs some or all of the functions with respect to Plans which otherwise would be performed by Company, including without limitation claims adjudication, utilization review, utilization management and Physician credentialing.
Delegated Entity. - means a local government (or other governmental entity such as a tribal
Delegated Entity means a First Tier Entity with whom HPSM has contracted to perform specified delegated functions on HPSM’s behalf in accordance with state, local, and federal laws, rules, and guidelines, as well as in accordance with HPSM policies and procedures.
Delegated Entity. (1) as the term applies to arrangements in California with respect to which Company is operating as a Blue Cross and/or Blue Shield licensee, means (i) a risk-bearing organization, organized delivery system, limited or specialized licensed health plan or other risk-bearing entity as defined by California law, or (ii) a full service licensed health plan where it is reasonably necessary because Company does not have reasonable capacity to provide or administer coverage in those geographic areas or specialty services; and (2) as the term applies otherwise, means an entity that is not an Affiliate of Company to the extent that such entity (i) maintains its own contracts with Physicians separate from any contracts between Company and Physicians, and, (ii) by agreement with Company, (A) agrees to provide Plan Members with access to such Physicians pursuant to terms of such agreements; and (B) performs some or all of the functions with respect to Plans which otherwise would be performed by Company, including without limitation claims adjudication, utilization review, utilizations management and Physician credentialing.
Delegated Entity means (a) a full-service, licensed health plan with which it is reasonably necessary for Company to contract because Company does not have reasonable capacity to provide specialty services or administer coverage in the geographic areas served by such health plan; and (b) an entity that is not an Affiliate of Company to the extent that such entity (i) maintains its own contracts with Healthcare Providers separate from any contracts between Company and Healthcare Providers, and,
Delegated Entity means a legal or natural person accredited and under continuous assessment by a competent aviation authority, which may conduct certain certification or oversight tasks under this Regulation;
Delegated Entity or “Delegated Provider” means a risk bearing organization as defined in Health and Safety Code section 1375.4, that when applicable, is financially responsible for Covered Services provided by Provider and the entity to whom Provider shall seek payment from for those delegated Covered Services.