Downstream Entity definition

Downstream Entity has the meaning set out in 42 C.F.R. § 422.500(b) and § 423.501. Downstream Entities include any of Dentist’s subcontractors and their subcontractors down to the level of the ultimate provider of dental and administrative goods and services to MA Members.

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Downstream Entity means any party that enters into an agreement with CDO or with another Downstream Entity for purposes of providing services related to the agreement between CDO and CMS. The term “downstream entity” is intended to reach the entity that directly provides services to Consumers.

Downstream Entity means any party that enters into a written arrangement, acceptable to ODM, with a first tier or related entity or below the level of a first tier or related entity to provide administrative services for Ohio Medicaid- eligible individuals. These arrangements continue down to the level of the ultimate provider of the administrative services.

Examples of Downstream Entity in a sentence

• Dentist shall prohibit any Affiliated Party or Downstream Entity that appears on any of the above-listed databases or who has opted out of Medicare from doing any work directly or indirectly related to the Covered Services.

• If Dentist contracts with a Downstream Entity to fulfill Dentist’s obligations hereunder, Dentist shall require the Downstream Entity by written agreement to comply with all provisions of these Medicare Advantage Requirements.

• Dentist may not retaliate against any Affiliated Party or Downstream Entity for reporting in good faith compliance concerns and suspected or actual misconduct.

• MA Plan may only delegate functions to Dentist or a Downstream Entity pursuant to a written agreement specifying the activities and responsibilities of each party, including provisions for revocation of delegation activities and reporting requirements.

• Dentist shall check appropriate databases at least monthly to determine whether any Affiliated Party or Downstream Entity has been suspended or excluded from participation in the Medicare program or any other federal health care program.

More Definitions of Downstream Entity

Downstream Entity means any party that enters into a written arrangement, acceptable to Centers for Medicare and Medicaid Services (“CMS”), with persons or entities involved with the MA benefit, below the level of the arrangement between a health plan that operates a Medicare Part C program (“MA Plan”) and a First Tier Entity. These written arrangements continue down to the level of the ultimate provider of both health and administrative services. Dental Office is a Downstream Entity of LIBERTY.

Downstream Entity means any party that enters into an agreement with a Delegated Entity or with another downstream entity for purposes of providing administrative or health care services related to the agreement between a Delegated Entity and Plan.

Downstream Entity. Any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the MA benefit, below the level of the arrangement between an MA Organization (or applicant) and a First Tier Entity. These written arrangements continue down to the level of the ultimate provider of both health care and administrative services. For purposes of this Addendum, Downstream Entity shall mean Participating Dentist.

Downstream Entity means any party that enters into a written arrangement, below the level of the arrangement between the DCO and a first-tier entity. These written arrangements continue down to the level of the ultimate provider of both health and administrative services.

Downstream Entity shall have the meaning set forth in Exhibit D, Schedule 1 of this Exhibit D.

Downstream Entity means any party, including an agent or broker, that enters into an agreement with a Delegated Entity or with another Downstream Entity for purposes of providing administrative or health care services related to the agreement between the Delegated Entity and Health Plan. The term “Downstream Entity” is intended to reach the entity that directly provides administrative services or health care services to qualified individuals, qualified employers, or qualified employees and their dependents (as such terms are defined in 45 C.F.R.

Downstream Entity has the same definition that in 42 C.F.R. §§ 422.2 and 423.4, which, at the time of execution of this MA PPO Addendum, means any party that enters into a written arrangement, acceptable to CMS, with persons or entities involved with the MA benefit, below the level of the arrangement between The Plan and a First-Tier Entity, such as Group. These written arrangements continue down to the level of the ultimate provider of both health and administrative services.