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The term \u201cDownstream Entity\u201d 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.", "size": 5, "hash": "3b10919216790a7998354318a2c6626d", "id": 9}, {"samples": [{"hash": "kfTTppUD2Sa", "uri": "/contracts/kfTTppUD2Sa#downstream-entity", "label": "Blue Cross Medicare Advantage (Ppo) Addendum", "score": 34.7853813171, "published": true}, {"hash": "dyq6N37XdTr", "uri": "/contracts/dyq6N37XdTr#downstream-entity", "label": "Blue Cross Medicare Advantage (Ppo) Addendum", "score": 34.5937690735, "published": true}], "snippet_links": [{"key": "time-of-execution", "type": "clause", "offset": [76, 93]}, {"key": "the-arrangement", "type": "clause", "offset": [268, 283]}, {"key": "the-plan", "type": "clause", "offset": [292, 300]}, {"key": "tier-entity", "type": "definition", "offset": [313, 324]}, {"key": "health-and", "type": "clause", "offset": [428, 438]}, {"key": "administrative-services", "type": "definition", "offset": [439, 462]}], "snippet": "has the same definition that in 42 C.F.R. \u00a7\u00a7 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.", "size": 4, "hash": "1c3ba795b5a0b9dc98e01c105a584411", "id": 10}], "next_curs": "Cl4SWGoVc35sYXdpbnNpZGVyY29udHJhY3RzcjoLEhpEZWZpbml0aW9uU25pcHBldEdyb3VwX3Y1NiIaZG93bnN0cmVhbS1lbnRpdHkjMDAwMDAwMGEMogECZW4YACAA", "definition": {"title": "Downstream Entity", "snippet": "has the meaning set out in 42 C.F.R. \u00a7 422.500(b) and \u00a7 423.501. Downstream Entities include any of Dentist\u2019s subcontractors and their subcontractors down to the level of the ultimate provider of dental and administrative goods and services to MA Members.", "size": 108, "id": "downstream-entity", "examples": ["Dentist shall prohibit any Affiliated Party or <strong>Downstream Entity</strong> 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 <strong>Downstream Entity</strong> to fulfill Dentist\u2019s obligations hereunder, Dentist shall require the <strong>Downstream Entity</strong> by written agreement to comply with all provisions of these Medicare Advantage Requirements.", "Dentist may not retaliate against any Affiliated Party or <strong>Downstream Entity</strong> for reporting in good faith compliance concerns and suspected or actual misconduct.", "MA Plan may only delegate functions to Dentist or a <strong>Downstream Entity</strong> 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 <strong>Downstream Entity</strong> has been suspended or excluded from participation in the Medicare program or any other federal health care program.", "Dentist shall notify MA Plan immediately in writing if Dentist, an Affiliated Party, or any <strong>Downstream Entity</strong> is suspended or excluded from the Medicare program, or any other federal or state program monitored as described in Sections 1.19.2 or 1.19.3.", "Dentist and MA Plan shall comply with all applicable Medicare laws, regulations and CMS instructions and shall ensure that any of their contractors, subcontractors, <strong>Downstream Entity</strong> or related entity complies with all applicable Medicare laws, regulations and CMS instructions.", "MA Plan retains the right to approve, suspend, or terminate any arrangement between Dentist and a selected <strong>Downstream Entity</strong> with respect to services provided under these Medicare Advantage Requirements.", "Dentist shall require any <strong>Downstream Entity</strong> from which Dentist obtains information for submission to MA Plan to represent and warrant that the information shall be accurate, complete and truthful, and to acknowledge that MA Plan may use the information for the purpose of obtaining federal funds.", "Dentist shall include in its written agreement with a <strong>Downstream Entity</strong> any and all provisions required to be included by Medicare law and regulations."], "related": [["downstream-affiliate", "Downstream Affiliate", "Downstream Affiliate"], ["downstream", "Downstream", "Downstream"], ["midstream-assets", "Midstream Assets", "Midstream Assets"], ["pjm-entities", "PJM Entities", "PJM Entities"], ["upstream", "Upstream", "Upstream"]], "related_snippets": [], "updated": "2025-07-23T06:14:19+00:00"}, "json": true, "cursor": ""}}