Group Provider definition

Group Provider means an organization that provides specialty mental health services through two or more individual providers. Group providers include entities such as independent practice associations, hospital outpatient departments, health care service plans, and clinics.

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Group Provider means a provider as defined in Title 9, CCR, Section 1810.218.2.

Group Provider means an organization that provides rehabilitative mental health services through two or more individual providers, such as independent practice associations. Group providers do not include hospital-based outpatient providers, county owned and operated providers, private organizational providers, or administrative service organizations.

Examples of Group Provider in a sentence

• Group and/or each Group Provider shall provide to Blue Shield, on request, credentialing information, in such form as reasonably required by Blue Shield.

• Group shall promptly notify Blue Shield of receipt of any claims, including professional liability claims filed or asserted by a Member against Group or a Group Provider.

• In the event a Group Provider terminates his/her relationship with a Member, Group shall assist the Member in selecting another Group Provider for the provision of Capitated Professional Services.

• The Group may refuse to compensate a Group Provider for such services to the extent permitted in its contract with the Group Provider providing the service.

• Thereafter, and within such time frames as set forth in the Provider Manual, Group shall make an initial determination, and so advise Blue Shield in writing, as to which of such claims are for In-Network Services, which are for Out-of-Network Services provided by a Group Provider, and which are for Out-of-Network Services provided by other than a Group Provider.

• In all cases where the Group and/or a Group Provider has made a determination regarding the Medical Necessity of a medical service requested or provided to a Member, Group shall, upon the request of Blue Shield, assist Blue Shield in determining the Medical Necessity of such service and provide relevant medical records to Blue Shield and participate in any grievance, arbitration, and/or other proceedings in which such Medical Necessity determination is an issue.

• In the event a PCP, during the term of this Agreement, elects to close his/her practice to new Members, or cease to be a Group Provider, Group shall give Blue Shield sixty (60) days prior written notice of such closure.

• Group further agrees that the procedures set forth in this Paragraph 11.1 may be used in the event that a Group Provider has a dispute with Group.

• In the event that Government Officials or Blue Shield find any deficiencies in such facilities or records, Group, or Group Provider, as applicable, shall have thirty (30) days to substantially correct such deficiencies which are identified by such Government Officials or Blue Shield.

• In the event Group terminates a contract with a Group Provider for deficiencies in the quality of care provider, Group shall give notice of the action to the appropriate licensing and disciplinary bodies.

More Definitions of Group Provider

Group Provider means a Provider, as defined herein, with two or more physicians or other professionals practicing together as a proprietorship, partnership, PC, PLLC, PLLP, PA or any combination of the foregoing. References herein to “Provider” shall mean the Group Provider and each physician or other professional now or hereafter practicing and billing as part of the group, and all practice sites now existing or hereafter added by Group Provider as permitted hereunder.

Group Provider is a physician (“Group Physician”), ancillary provider, or other provider with whom Group has entered into a contract for the provision of Capitated Professional Services.

Group Provider means a provider as Title 9, CCR, Section 1810.218.2.

Group Provider means a duly licensed specialist or general dentist who practices with Provider as an employee, partner, shareholder, or contractor.

Group Provider means a Participating Physician who has been selected by and/or assigned Enrollees to provide Primary Care Covered Services, Billaboves, and coordinating all referral Covered Services.

Group Provider or “Provider” means an appropriately licensed health care professional who has successfully completed the credentialing procedure in accordance with Section 2.1 (d) and who is a shareholder, member, partner or employee of Group or sub-contracted health care professional who will provide services on behalf of Group, pursuant to this Agreement. Each non-employed or sub-contracted health care professionals shall agree to abide by the terms of this Agreement.