Managed care provider definition

Managed care provider means an organization:
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Managed care provider or "MCP" means an organization:
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Managed care provider means either a primary care provider or a health maintenance organization.
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Examples of Managed care provider in a sentence

  • Contractor:Willamette Dental GroupTitle:DCO Provider AgreementContract Type:RevenueDescription: Managed care provider contract for reimbursable Expanded Practice Dental Hygienist services provided by the Community Health Centers of Lane CountySelection Process:None.

  • This is not a guarantee the Managed care provider will utilize your agency, however.

  • Particular areas of experience include:  Managed care provider and member disputes. Licensure and regulatory issues with the Department of Managed Health Care, Department of Insurance, and Department of Health Services. HIPAA compliance for "Covered Entities" and employers Peer review and health plan/provider relations. Medi-Cal regulations and reimbursement appeals.

  • Managed care provider organizations orchestrate employed and affiliated providers—such as individual physicians, physician groups, hospitals, and outpatient clinics—to manage the care utilization of a particular Medicare Advantage patient population.

  • Restrictions and certifications: Managed care provider agreements may impose utilization restrictions, certification and insurance requirements and other restrictions that are inconsistent with tribal rights.

  • Managed care provider organizations are medical groups that employ or affiliate with a significant number of primary care physicians and specialists to ensure the coordination of patient care and control the costs of delivering proper care to Medicare Advantage members.

  • Issue if no United Way people don’t get same access to services.• Managed care provider directories are online (in searchable form) and phone number to call.

  • Particular areas of experience include:  Managed care provider and member disputes. Licensure and regulatory issues with the Department of Managed Health Care, Department of Insurance, and Department of Health Services. HIPAA compliance for "Covered Entities" and employers Peer review and health plan/provider relations. Medi-Cal regulations and reimbursement appeals. Regulatory compliance and liability exposures in clinical research. Litigation risk management for health care organizations.


More Definitions of Managed care provider

Managed care provider any physician, nurse practitioner, physician’s assistant or other licensed healthcare professional of any Managed Care Company or any Group Member. “Mandatory Prepayment Date”: as defined in Section 2.12(e). “Material Adverse Effect”: (a) a material adverse change in, or a material adverse effect on, the operations, business, assets, properties, liabilities (actual or contingent) or condition (financial or otherwise) of Holdings and its Subsidiaries, taken as a whole; (b) a material impairment in the perfection or priority of the Administrative Agent’s Lien on the Collateral or a material adverse effect upon the legality, validity, binding effect or enforceability against the Loan Parties of any Loan Document; or (c) a material adverse effect on the ability of the Loan Parties to perform their obligations (including their payment obligations) under the Loan Documents. “Materials of Environmental Concern”: any substance, material or waste that is defined, regulated, governed or otherwise characterized under any Environmental Law as hazardous or toxic or as a pollutant or contaminant (or by words of similar meaning and regulatory effect), any petroleum or petroleum products, asbestos, polychlorinated biphenyls, urea-formaldehyde insulation, toxic molds or fungus, and radioactive substances. “Medicaid”: the medical assistance programs administered by state agencies and approved by
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Managed care provider means any physician, nurse practitioner, physician’s assistant or other licensed healthcare professional of Holdings or any of its Subsidiaries or any Managed Care Company.
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Managed care provider means an entity with which the Program has directly contracted to provide or arrange with Participating Providers for the provision, coordination, continuity and monitoring of Covered Services to Members. Also known as the “Coordinated Provider Entity” or “CPE”.
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Related to Managed care provider

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • 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.

  • Primary care provider means a participating provider who supervises, coordinates, or provides initial care or continuing care to a covered person, and who may be required by the health carrier to initiate a referral for specialty care and maintain supervision of health care services rendered to the covered person.

  • 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.

  • Health care provider or "provider" means:

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

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

  • Care provider means a duly qualified or licensed home health aide or homemaker, personal care aide or nurse provided through a licensed home health care agency or referred by a licensed referral agency or licensed nurses registry.

  • 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).

  • 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:

  • Family child care provider means a person who: (a) Provides

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

  • Emergency medical care provider means an individual who has been trained to provide emergency and nonemergency medical care at the first responder, EMT-basic, EMT-intermediate, EMT-paramedic, paramedic specialist or other certification levels recognized by the department before 1984 and who has been issued a certificate by the department.

  • 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.

  • Indian Health Care Provider means a health care program operated by the Indian Health Service (IHS) or by an Indian Tribe, Tribal Organization, or Urban Indian Organization (otherwise known as an I/T/U) as those terms are defined in § 4 of the Indian Health Care Improvement Act (25 USC § 1603). Indian Health Care Provider includes a 638 Facility and provision of Indian Health Service Contract Health Services (IHS CHS).

  • 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.

  • 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).

  • 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.

  • Healthcare provider means a healthcare practitioner, person, or facility licensed, authorized, certified, registered, or regulated under title 33, title 63, title 68, federal law or order, or an executive order of the governor, including but not limited to any employees, agents, or contractors of such a practitioner, person, or facility, and residents, interns, students, fellows, or volunteers of an accredited school or of such school's affiliated teaching or training hospitals or programs in this state;

  • 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.

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

  • ACS means “asset-controlling supplier” as that term is defined in the Cap and Trade Regulations.

  • HMO means any health maintenance organization, managed care organization, any Person doing business as a health maintenance organization or managed care organization, or any Person required to qualify or be licensed as a health maintenance organization or managed care organization under applicable federal or state law (including, without limitation, HMO Regulations).

  • Licensed health care professional means a person who possesses a professional medical license that is valid in Oregon. Examples include, but are not limited to, a registered nurse (RN), nurse practitioner (NP), licensed practical nurse (LPN), medical doctor (MD), osteopathic physician (DO), respiratory therapist (RT), physical therapist (PT), physician assistant (PA), or occupational therapist (OT).

  • 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.