Managed Care Network definition

Managed Care Network means a network of “ Participating Providers” that is, physicians hospitals, other healthcare providers that participate in a network established and maintained by the Contractor, having entered into agreements with the Contractor to provide healthcare services to plan participants for a negotiated reimbursement rate. A healthcare provider that does not participate in the Contractor’s established network but enters into a limited “case rate” agreement shall be considered a non-Network or non-participating provider.

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Managed Care Network. Group of Network Providers who have entered into or are governed by contractual arrangements under which they agree to provide health care services to Participants and accept negotiated fees for these services. Network Pharmacy: Pharmacy which has entered into an agreement with us or our affiliate or subcontractor to provide prescription drug services to Participants. Network Provider: Health care provider who participates in one of our Managed Care Networks. Overpayments: Payments that exceed the amount payable under the Plan (for example, because of a provider billing error, retroactive or inaccurate eligibility information, coordination of benefits, Medicare disputes, or missing information), and other overcharges made by providers, including hospitals discovered during the course of a hospital ▇▇▇▇ audit. Participant: Subscriber or dependent who is covered by the Plan. Plan: The Plan to which this Agreement applies, but only with respect to those provisions of the Plan relating to the self-funded health benefits we are administering, as described in the Description of Benefits.

Managed Care Network means the Network of health care providers that have entered into contracts with Anthem and/or one or more of its Affiliates pursuant to which those providers have agreed to participate in the Anthem programs that are to be provided pursuant to the Health Benefit Plan.

Examples of Managed Care Network in a sentence

Additionally, per the Federal Managed Care Network Adequacy Final Rule requirements, 100% of direct service practitioners (psychotherapists, psychiatrists, case managers, etc.) must complete cultural competence training within the past 12 months to meet annual reporting requirements.
In addition, Blue Shield may extend this Agreement to managed care arrangements established by Blue Shield subsidiaries, or by persons or entities utilizing the Managed Care Network which Blue Shield has established pursuant to agreements with CareTrust Networks and Blue Shield of California Life & Health Insurance Company.
When the BLUE CROSS Managed Care Network is utilized by an Affiliate or Other Payor, PARTICIPATING MEDICAL GROUP agrees to provide services to Covered Persons of that Affiliate or Other Payor in accordance with the terms of this Agreement.
When an Other Payor utilizes the Managed Care Network, such Other Payor shall comply with the terms of this Agreement.
In the event the BLUE CROSS Managed Care Network is to be utilized by an Other Payor that has operational requirements that are materially different from those required under this Agreement, BLUE CROSS agrees to notify PARTICIPATING MEDICAL GROUP in writing thirty (30) days prior to the commencement of such utilization.
In addition, Blue Shield may extend this Agreement to managed care arrangements established by Blue Shield subsidiaries, or by persons or entities utilizing the Managed Care Network which Blue Shield has established pursuant to agreements with CareTrust Networks, Blue Shield of California Life & Health Insurance Company and Blue Shield Promise.
In the event Anthem enters into an arrangement with an Other Payor that does not require such active encouragement of the use of the Managed Care Network, Provider shall be allowed to decline to provide services to such Other Payor.
We will make available to Participants a Managed Care Network, located in agreed to geographical sites with Network Providers who render health care and/or mental health and substance abuse care.
When an Other Payor utilizes the Managed Care Network, such Affiliate or Other Payor shall comply with the terms of this Agreement.
If BLUE CROSS contracts with another ▇▇▇▇-▇▇▇▇▇ licensed health care service plan to permit access to the Managed Care Network.

More Definitions of Managed Care Network

Managed Care Network means the network of health care providers that have entered into contracts with BLUE CROSS and/or one or more of its Affiliates pursuant to which those providers have agreed to participate in BLUE CROSS SENIOR SECURE and other programs that are to be conducted pursuant to Benefit Agreements.