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

  • This Medicare/Medicaid Advantage and Part D and Other Government Sponsored Programs Addendum (“Medicare/Medicaid Addendum”) is entered into by and between Outcomes Operating, Inc.

  • If Government Sponsored Programs Providers has any arrangements, in accordance with the terms of the Agreement, with affiliates, subsidiaries, or Downstream Entities, directly or through another person or entity, to perform any health care or administrative services under a QHP, Government Sponsored Programs Providers shall ensure that all such arrangements are in writing, duly executed, and include all the terms contained in this Section 1.5.

  • 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.

  • Government Sponsored Programs Providers acknowledges and agrees that the Department of Health and Human Services (HHS) Secretary and Office of Inspector General (OIG) and their designees have the right to evaluate, through audit, inspection, or other means, the performance of Government Sponsored Programs Providers, its related entities and its downstream entities.

  • Except in emergency situations or upon prior approval of Blue Shield, Government Sponsored Programs Provider must make any necessary referrals to another Government Sponsored Programs Provider and/or contracted hospital participating in the Member’s benefit plan.

  • Reinstatement as a Government Sponsored Programs Provider, which has been suspended or terminated with cause, if the suspension or termination arose in correction with the recredentialing of a Provider or any of its Practitioners, may be approved if it is established to the satisfaction of the Blue Shield credentialing committee.

  • Government Sponsored Programs Provider shall notify Blue Shield of any referral to a non-Government Sponsored Programs Provider or to a non-participating hospital and shall document the reason for such referral in the Member’s records.

  • Government Sponsored Programs Provider will participate in and abide by the decisions of all quality assurance, utilization review, and Member complaint and grievance systems applicable to Managed Care Plans.

  • The participation of any Provider as a Government Sponsored Programs Provider shall be effective upon acceptance by Blue Shield of Provider’s application, Provider’s satisfaction of all applicable credentialing criteria, and execution of the Government Sponsored Programs Provider Agreement by Blue Shield.

  • Government Sponsored Programs Provider acknowledges and agrees that to the extent CMS directs such revocation, Highmark shall provide immediate written notice of such to Government Sponsored Programs Provider, and such revocation shall become effective as directed by CMS.