Nonparticipating provider definition

Nonparticipating provider means a person, health care provider, practitioner, facility, or entity, acting within their scope of practice, that does not have a written contract to participate in a managed health care system's provider net- work, but provides health care services to enrollees of pro- grams authorized under this chapter or other applicable law whose health care services are provided by the managed health care system.

Nonparticipating provider means a person, health care provider, practitioner, facility, or entity acting within their scope of prac- tice and licensure that:

Nonparticipating provider means a provider who is not a participating provider;

Examples of Nonparticipating provider in a sentence

• Non-participating provider benefits are not available for the services listed in items 2 and 3 above.

• Non-participating provider benefits are not available for the services listed in items 2, 4 and 7 below.

• You will be reimbursed directly according to the following Reimbursement Schedule: Non-participating provider reimbursement schedulePROFESSIONAL FEESVision Examination, up to$ 36.00OPHTHALMIC MATERIALS(pair)Single Vision Lenses, up to$ 28.00Bifocal Lenses, up to45.00Trifocal Lenses, up to56.00Lenticular Lenses, up to80.00One Year Scratch ProtectionN/APolycarbonate Lens MaterialN/AFrames, up to$ 45.00-or-CONTACT LENSES (In lieu of all other benefits for the benefit period.

• Non-participating provider is a provider (doctor, hospital, pharmacy, etc.) that does not sign a contract to participate in the Contractor’s provider network.

• The Member could be billed by a Participating Provider for services that Capital determines are not Medically Necessary but the Member chooses to have the service anyway.A Nonparticipating provider is not obligated to accept Capital’s Preauthorization denial or determination of Medical Necessity, and therefore, may bill a Member for services determined not to be Medically Necessary.

More Definitions of Nonparticipating provider

Nonparticipating provider means a person who provides hospital or medical care pursuant to the Oklahoma Medicaid Program but does not have a managed care health services contract or subcontract within the Oklahoma Medicaid Healthcare Options System;

Nonparticipating provider means a health care entity or health care professional not in the contractor's participating provider network.

Nonparticipating provider means, with respect to the

Nonparticipating provider means a healthcare provider who has not entered into a contract with a healthcare plan for the delivery of medical services;

Nonparticipating provider means a provider who is not contracted with the enrollee’s health care service plan to provide services under the enrollee’s plan contract.

Nonparticipating provider means a health care

Nonparticipating provider means a provider who is