Participating healthcare provider definition

Participating healthcare provider means a healthcare
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Participating healthcare provider means a health care Provider that has a contractual agreement with a Host Blue.
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Participating healthcare provider means a healthcare provider with whom a health insurance entity has a network provider agreement or contract;
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Examples of Participating healthcare provider in a sentence

  • In these situations, Plan Participant may be liable for the difference between the amount that the Non- Participating healthcare provider bills and the payment Claims Administrator will make for the covered services as set forth in this paragraph.

  • A requirement that the Company provide Executive and Executive’s eligible dependents with coverage under the Benefit Plans will not be satisfied unless the coverage is no less favorable than that provided to Executive and Executive’s eligible dependents immediately prior to Executive’s termination of employment.

  • The decision to shorten the length of Inpatient stay to less than that stated above must be made by the attending Participating healthcare provider and the mother.‌ Section XIV: Newborn Care‌‌‌ Newborn care claims from FQHCs and RHCs are administered by Conduent.

  • Participating healthcare provider sites will be responsible for paying 35% of the monthly fees directly under contracts they sign with ETC(s).

  • Types of Business Ownership Carousel Brainstorming Cooperative Learning Five Plus OneGuided Practice KWLSocratic SeminarTextbooks Internet Computers Software1.

  • In these situations, Plan Participant may be liable for the difference between the amount that the Non- Participating healthcare provider bills and the payment the Plan will make for the covered services as set forth in this paragraph.


More Definitions of Participating healthcare provider

Participating healthcare provider means an entity that has executed a contract with Wyoming Medicaid and has a qualifying taxonomy code.
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Participating healthcare provider means a healthcare provider that has a healthcare contract with a contracting entity to provide healthcare services to enrollees with the expectation of receiving payment from the contracting entity or a healthcare insurer affiliated with the contracting entity; and
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Participating healthcare provider means a healthcare Provider that has a contractual agreement with a Host Blue.
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Participating healthcare provider means a Healthcare Provider who has entered into a valid written contract with Company (directly or indirectly through a Healthcare Provider Organization, Healthcare Provider Group or other entity authorized by the Healthcare Provider at the time the claim arose) to provide Covered Services to Plan Members and, where applicable, who meets Company’s credentialing requirements, during the effective period of such a contract.
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Related to Participating healthcare provider

  • 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).

  • 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;

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

  • Health care provider or "provider" means:

  • Participating Hospital means an Administrator Hospital that has an agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide Hospital services to participants in the Participating Provider Option program.

  • 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.

  • 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).

  • Healthcare Professional means any member of the medical, dental, pharmacy or nursing professions or any other person who in the course of his or her professional activities may prescribe, recommend, purchase, supply, or administer a pharmaceutical product.

  • 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.

  • Participating Home Infusion Therapy Provider means a Home Infusion Therapy Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Health care professional means a physician or other health care practitioner licensed, accredited or certified to perform specified health care services consistent with state law.

  • Primary care provider (PCP) means, for the purpose of this plan, professional providers that are family practitioners, internists, and pediatricians. For the purpose of this plan, gynecologists, obstetricians, nurse practitioners, and physician assistants may be credentialed as PCPs. To find a PCP or check that your provider is a PCP, please use the “Find a Doctor” tool on our website or call Customer Service.

  • Non-Participating Home Infusion Therapy Provider means a Home Infusion Therapy Provider who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Participating Retail Health Clinic means a Retail Health Clinic which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • COVERED HEALTHCARE SERVICES means any service, treatment, procedure, facility, equipment, drug, device, or supply that we have reviewed and determined is eligible for reimbursement under this plan.

  • 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)).

  • Participating Orthotic Provider means an Orthotic Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • 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.

  • Participating Clinical Professional Counselor means a Clinical Professional Counselor who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Non-Participating Clinical Professional Counselor means a Clinical Professional Counselor who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Mental health services provider means an individual, licensed or unlicensed, who performs or purports to perform mental health services, including a:

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

  • Federal Health Care Program has the meaning set forth in 42 U.S.C. 1320a-7b(f).

  • Non-Participating Hospital means an Administrator Hospital that does not meet the definition of a Participating Hospital.

  • Teaching Hospital means a hospital that trains students to become physicians, nurses, or other health or laboratory personnel.

  • Allied Health Professional means a person registered as an allied health professional with the Health Professions Council;