Other Payors definition

Other Payors means persons or entities, utilizing the Network(s)/Plan Program(s) pursuant to an agreement with Anthem or an Affiliate, including without limitation, other Blue Cross and/or Blue Shield Plans that are not Affiliates, and employers or insurers providing Health Benefit Plans pursuant to insured, self-administered or self-insured programs.
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Other Payors are employers, insurance companies, associations, health and 27 welfare trusts, and other organizations with which Blue Shield contracts to provide 1 administrative services for plans provided by those entities that are not underwritten 2 by Blue Shield (including both local and Blue Cross/Blue Shield National Accounts 3 Programs), as well as other entities to which Blue Shield has extended this 4 Agreement pursuant to managed care arrangements established by Blue Shield 5 subsidiaries, or by persons or entities using the network Blue Shield has established 6 pursuant to agreements with CareTrust Networks and Blue Shield of California Life 7 & Health Insurance Company.” BSA § 2.18 (2008 amendment) (emphasis added).
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Other Payors means persons or entities, pursuant to an agreement with Wellpoint or an Affiliate, that access the rates, terms or conditions of this Agreement with respect to certain Network(s), excluding Government Programs unless otherwise set forth in any Participation Attachment(s) for Government Programs. Other Payors include, without limitation, employers or insurers providing Health Benefit Plans pursuant to partially or wholly insured, self- administered or self-insured programs.
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Examples of Other Payors in a sentence

  • The identity of Other Payors shall be disclosed in the Provider Manual.

  • Blue Shield shall require that: (a) the health programs of Other Payors include provisions to encourage the use of Blue Shield contracting providers, and (b) Other Payors comply with performance standards relating to timely processing of claims which meet or exceed the time requirements set forth in California law.

  • BLUE CROSS will disclose upon initial signing of this Agreement and within 30 days of receipt of a written request from PARTICIPATING MEDICAL GROUP a summary of all Other Payors and Affiliates currently eligible to pay the negotiated rates under this Agreement as a result of their arrangement with BLUE CROSS.

  • Each Restricted Subsidiary is duly organized, validly existing and in good standing (or their equivalents under applicable local law) under the laws of the jurisdiction in which it is incorporated or organized, as the case may be, has full and adequate power to own its Property and conduct its business as now conducted, and is duly licensed or qualified and in good standing in each jurisdiction in which the failure to be so qualified would have a Material Adverse Effect.

  • Anthem will disclose upon initial signing of this Agreement and within thirty (30) days of receipt of a written request from Provider a summary of all Other Payors currently eligible to pay the negotiated rates under this Agreement as a result of their arrangement with Anthem.

  • Provider agrees to notify Anthem or the applicable Other Payors or Affiliates, thirty (30) days prior to filing a lien or sending bill(s) to collection.

  • Other Payors that utilize Cypress’s dental network may continue to utilize or request that claim payments and other information be transmitted solely by mail.

  • Therefore, CONTRACTOR will (1) provide transportation services to all Out-of-Area Individual(s) as scheduled by the BROKER, (2) directly bill the other Regional Centers or entities responsible for payments for Out-of-Area Individual(s) transported by CONTRACTOR (the “Other Payors”) and (3) arrange with CENTER’s BROKER for separate collection of payments for such services from the Other Payors.

  • Access to the Anthem Workers' Compensation Network may be sold, leased, transferred or conveyed to Other Payors, which may include workers' compensation insurers, self insurer's security fund, a group of self-insured employers, a joint powers of authority, the state, third party administrators, or other covered employers as permitted under the State of Kentucky's workers' compensation laws and regulations.

  • I Hereby Authorize Family Medical Specialties To Furnish Information To My Insurance Carriers Or Other Payors Concerning My Illness &Treatments & I Hereby Assign To Family Medical Specialties - All Payments For Medical Services Rendered To My Dependents Or Myself.

Related to Other Payors

  • Payors shall have the meaning set forth in Section 3.27.

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • Third Party Payor means any governmental entity, insurance company, health maintenance organization, professional provider organization or similar entity that is obligated to make payments on any Account.