Managed Care Agreement definition

Managed Care Agreement means the amended and restated the managed care agreement, dated as of May 28, 2003 and as amended, supplemented or modified to and including the date hereof, entered into between the Borrower and Merck, provided that, in the event that such agreement is replaced to the extent permitted by clause (n)(i) of Article VII references herein to the "Managed Care Agreement" shall be deemed to refer to such replacement agreement or agreements.
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Managed Care Agreement means any contract with a third party payor, including, without limitation, employers, insurance companies and managed care companies, to provide health care services to patients. MIA 302723-6.000000.0000 0.71
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Managed Care Agreement means a written contract between a third-party Payer or purchaser of health care services and the MCO whereby the MCO agrees to provide a network of health care facilities and providers who have agreed to be bound by, and to provide managed health care services to Eligible Subscribers in accordance with, the terms of Managed Care Agreements.
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Examples of Managed Care Agreement in a sentence

  • If there is a conflict between the Manual and the Managed Care Agreement or NMAC rules, the Managed Care Agreement and NMAC rules will control.

  • Having entered into the Managed Care Agreement, Tenet was aware that there was a risk of non- payment if a situation like the one at bar occurred.

  • The Provider may choose to “opt-out” of any Managed Care Agreement executed by Gateway that the Provider determines is not in his/her best interests.

  • The Provider may not, however, negotiate or execute contracts independently or as a participant in another network with any party after the Provider has received from Gateway pursuant to Section 4.4 an executed Managed Care Agreement between Gateway and that party.

  • In the event that the Provider does not reject a Managed Care Agreement within ten (10) days of receipt pursuant to this subsection 2.3(b) and Section 4.4, (s) he will be deemed to have accepted such agreement, and the Agreement will be deemed to be incorporated by reference into, and made a part of, this Agreement, without the necessity of amending this Agreement, and the Provider will be bound by its terms and conditions.

  • However, Gateway only shall enter into at-risk agreements with Health Maintenance Organizations licensed to do business in Virginia, or other entities that are licensed or otherwise permitted by the Virginia Bureau of Insurance, to enter into at- risk agreements with Gateway.Billing Billing and Collection: Subject to Section 3.9, the Provider shall be responsible for billing and collecting for all Medical Services (s) he provides to Subscribers pursuant to any Managed Care Agreement.

  • Tenet responds solely on the theory that the request for refund provision of the Managed Care Agreement is in conflict with state law, specifically § 843.347(g) of the Texas Insurance Code.

  • In September 2005, UniCare notified Tenet that it was requesting a refund of the claim payment under the terms of the Managed Care Agreement because Sylvester’s benefits had terminated prior to her admission to the Hospital.After Tenet refunded the payment to UniCare, Tenet filed suit against UniCare in Harris County District Court in Houston, Texas, alleging breach of contract, negligent misrepresentation, and violations of the Texas Insurance Code.

  • Tenet alleges that Defendants’ motions for summary judgment should be denied because the Managed Care Agreement violates the Texas Insurance Code, § 843.347(g).

  • Once the Provider has become bound by a Managed Care Agreement, (s) he shall remain bound by it until the earlier of termination of this Agreement pursuant to Article 5 hereunder, or termination of the Managed Care Agreement pursuant to its terms.


More Definitions of Managed Care Agreement

Managed Care Agreement in this Section means the proposed Agreement for Managed Health Care Services for 1999, as it may be amended or supplemented in the future. The parties further acknowledge that, as of the date of this Contract, the Managed Care Agreement for 1999 has not been entered into and, as proposed, would not extend past September 30, 1999.
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Managed Care Agreement means a Managed Care Agreement between Novant and the Company and/or the Subsidiaries, to be entered into by the parties thereto at Closing, in a form mutually agreed upon by the parties thereto.
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Related to Managed Care Agreement

  • 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.

  • Managed care entity means either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other such entity administering the Medicaid program and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • 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.

  • Managed care means a system that provides the coordinated delivery of services and supports that are necessary and appropriate, delivered in the least restrictive settings and in the least intrusive manner. Managed care seeks to balance three factors:

  • Medicare Provider Agreement means an agreement entered into between CMS or other such entity administering the Medicare program on behalf of CMS, and a health care provider or supplier under which the health care provider or supplier agrees to provide items and services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • End User Agreement means any agreement that Eligible Users are required to sign in order to participate in this Contract, including an end user agreement, customer agreement, memorandum of understanding, statement of work, lease agreement, service level agreement, or any other named separate agreement.

  • Collaborative pharmacy practice agreement means a written and signed

  • 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.

  • Software Agreement means the agreements on the license and support of standard software.

  • 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.

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

  • Managed health care system means: (a) Any health care

  • Managed Care Organization (MCO means a contracted health delivery system providing capitated or prepaid health services, also known as a Prepaid Health Plan (PHP). An MCO is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law. An MCO may be a Chemical Dependency Organization (CDO), Dental Care Organization (DCO), Mental Health Organization (MHO), or Physician Care Organization (PCO).

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Customer Agreement means a written agreement entered into between Provider and any Customer pursuant to which a Customer orders BPO Services from Provider.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • User Agreement means an agreement for the provision of Access to the Services.

  • Reseller Agreement means the separate agreement between Customer and Reseller regarding the Services. The Reseller Agreement is independent of and outside the scope of This Agreement.

  • Hospital purchaser/provider agreement (HPPA agreement) means a negotiated agreement entered between the fund and the hospital for the cost of hospital treatment.

  • Customs Broker/Carrier Agreement means an agreement in form and substance satisfactory to the Agent among a Loan Party, a customs broker, freight forwarder, consolidator, or carrier, and the Agent, in which the customs broker, freight forwarder, consolidator, or carrier acknowledges that it has control over and holds the documents evidencing ownership of the subject Inventory for the benefit of the Agent and agrees, upon notice from the Agent, to hold and dispose of the subject Inventory solely as directed by the Agent.

  • Provider Agreements means all participation, provider and reimbursement agreements or arrangements now or hereafter in effect for the benefit of Tenant or any Manager in connection with the operation of any Facility relating to any right of payment or other claim arising out of or in connection with Tenant’s participation in any Third Party Payor Program.

  • PCI DSS means the Payment Card Industry Data Security Standard, issued by the Payment Card Industry Security Standards Council, as may be revised from time to time.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.