Government Sponsored Programs definition

Government Sponsored Programs means those government sponsored programs, as designated by Highmark, for which the Provider has been designated to participate, at Highmark’s sole discretion, which includes but is not limited those qualified benefit plans offered by Highmark or Health Plan, in its discretion, to individuals and/or families and/or small groups, as determined by Highmark on or off an American Health Benefit Exchange as defined in the Patient Protection and Affordable Care Act (P.L. 111-148) as amended from time to time.
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Examples of Government Sponsored Programs in a sentence

  • Where required by Act 68, Blue Shield will notify Government Sponsored Programs Provider in writing at least thirty (30) days before it implements any changes to its contracts, policies or procedures affecting Government Sponsored Programs Provider or the provision or payment of health care services to Members unless the change is required by Law.

  • Government Sponsored Programs Provider will adhere to all Laws applicable to the provision of professional health care services under this Agreement.

  • Payment for Covered Services provided to Members under the Government Sponsored Programs Provider Agreement may be derived in whole or in part from federal funds.

  • Government Sponsored Programs Provider shall have the right to appeal a suspension or termination initiated by Blue Shield based upon cause.

  • Such appeals shall be in writing and shall be addressed to the Blue Shield credentialing committee if the suspension or termination arose in connection with the recredentialing of Government Sponsored Programs Provider or any of its Practitioners.

  • Each Practitioner meets and will continue throughout the Term to meet all credentialing and recredentialing requirements as established by Blue Shield for participation as a Government Sponsored Programs Provider in the Government Sponsored Programs Provider network and as set forth in the Administrative Requirements.

  • All matters, disputes or controversies relating to the services performed by Government Sponsored Programs Providers or any questions involving professional ethics (including determinations of any Blue Shield committee that a Government Sponsored Programs Provider disputes) shall be considered and determined only by the Review Committee in the manner provided by the applicable provisions in the Bylaws and the Review Committee Guidelines, which are included in the BSOM or its successor.

  • Unless a longer time period is required by applicable statutes or regulations, Government Sponsored Programs Provider shall maintain such records and any related contracts for ten (10) years.

  • Blue Shield may reject an application to be a Government Sponsored Programs Provider, or may terminate the participation as a Government Sponsored Programs Provider, in accordance with the terms of the Government Sponsored Programs Provider Agreement, these Regulations and/or Administrative Requirements.

  • Providers enrolled in the Government Sponsored Programs network(s) must also comply with the provisions set forth in Part IV below.

Related to Government Sponsored Programs

  • Government Programs means (i) the Medicare and Medicaid Programs, (ii) the United States Department of Defense Civilian Health Program for Uniformed Services and (iii) other similar foreign or domestic Federal, state or local reimbursement or governmental health care programs.

  • Government Apprenticeship Programme “ means training which is funded by the Government via the National Apprenticeship Service.

  • Dependent care assistance program means a benefit plan

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Government assistance means a grant, loan, or tax increment financing that result in a financial benefit from an agency, commission, instrumentality, or other entity of the District government.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Government energy aggregation program means a program and

  • Government Lists means, collectively, (i) the Specially Designated Nationals and Blocked Persons Lists maintained by OFAC, (ii) any other list of terrorists, terrorist organizations or narcotics traffickers maintained pursuant to any of the Rules and Regulations of OFAC, and (iii) any similar lists maintained by the United States Department of State, the United States Department of Commerce or any other governmental authority or pursuant to any Executive Order.

  • OFAC Sanctions Programs means all laws, regulations, and Executive Orders administered by OFAC, including without limitation, the Bank Secrecy Act, anti-money laundering laws (including, without limitation, the Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism Act of 2001, Pub. L. 107-56 (a/k/a the USA Patriot Act)), and all economic and trade sanction programs administered by OFAC, any and all similar United States federal laws, regulations or Executive Orders, and any similar laws, regulators or orders adopted by any State within the United States.

  • Government school means a school established under section 5 of the Act, for the purpose of providing courses of instruction in pre-school, primary or secondary education.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has 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 been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Government data means any information, document, media, or machine readable material regardless of physical form or characteristics, that is created or obtained by the Government in the course of official Government business.

  • Sanctions Programs means any OFAC economic sanction program (including, without limitation, programs related to Crimea, Cuba, Iran, North Korea, Sudan and Syria).

  • Diagnostic clinical procedures manual means a collection of written procedures that describes each method (and other instructions and precautions) by which the licensee performs diagnostic clinical procedures; where each diagnostic clinical procedure has been approved by the authorized user and includes the radiopharmaceutical, dosage, and route of administration.

  • Government List means any of (i) the two lists maintained by the United States Department of Commerce (Denied Persons and Entities), (ii) the list maintained by the United States Department of Treasury (Specially Designated Nationals and Blocked Persons), and (iii) the two lists maintained by the United States Department of State (Terrorist Organizations and Debarred Parties).

  • Covered Government support contractor means a contractor (other than a litigation support contractor covered by 252.204-7014) under a contract, the primary purpose of which is to furnish independent and impartial advice or technical assistance directly to the Government in support of the Government’s management and oversight of a program or effort (rather than to directly furnish an end item or service to accomplish a program or effort), provided that the contractor—

  • Developed exclusively with government funds means development was not accomplished exclusively or partially at private expense.

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • 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.

  • Child Care Program means a person or business that offers child care.

  • Available government assistance means any governmental rental or housing payment benefits available to the individual or any household member.

  • Participating Retail Health Clinic means a Retail Health Clinic which has 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.

  • Participating Clinical Laboratory means a Clinical Laboratory which has 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.

  • Government Subcontract means a Contract that is a subcontract between the Company, any of its Subsidiaries or any of their respective Affiliates on the one hand, and any third party on the other hand, relating to a Contract between such third party and (i) any Governmental Authority or (ii) another party where the ultimate contracting party is a Governmental Authority. Government Subcontract includes all bids and proposals submitted to any party that may result in the award of a Government Subcontract.

  • OFAC Sanctions Program means any economic or trade sanction that OFAC is responsible for administering and enforcing. A list of OFAC Sanctions Programs may be found at xxxx://xxx.xxxxxxxx.xxx/resource-center/sanctions/Programs/Pages/Programs.aspx.