Participating Payer definition

Participating Payer or “Payer” means a public or private insurer, health service corporation, or health maintenance organization that has entered into an agreement with MDHHS to participate in PCMH Initiative.
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Participating Payer means a Payer which is either contracted directly with the Provider or has elected to subsidize a portion of the costs associated with translating, editing, processing and reporting of electronic Claims and other transactions on behalf of its contracted Providers. “Party or Parties” means, individually, a party to the Agreement, and, collectively, the parties to the Agreement, as set forth on the Purchase Order.
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Participating Payer means a payer that operates in rural counties and signs an agreement with the authority to participate in the global budget model;
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Examples of Participating Payer in a sentence

  • The Contractor shall review the results of its calculations performed as part of Section 3.2.A-C tasks with interested Participating ACOs and Payers, and shall work with such ACOs and Payers to reconcile any inconsistencies (such as conflicting Contractor and Participating Payer patient attribution counts) or other possible methodological or data quality concerns that Participating ACOs and Payers might identify, and shall do so as directed by the GMCB.

  • While the Centers for Medicare and Medicaid Services (CMS) is not a Participating Payer, Participating ACOs are contractually obligated to submit Medicare Shared Savings Program (MSSP) quality measures to the GMCB.

  • In the event that the validity or value of the Covered Service has been placed in dispute by the Covered Member, Participating Payer or Network in writing, and such dispute has been validated through the Participating Payer’s or Network’s appeals process, Simplicity may chargeback to the Provider the total amount of the applicable Complete Payment.

  • Provider will not separately bill or take steps to collect funds from a Covered Member, Participating Payer (or Participating Payer’s Claims Administrator), or Participating Plan for any Covered Services paid through the Simplicity Complete Payment Network (except that Provider may collect from the Covered Member the pre- Adjudicated co-payment and/or non-Covered Service amounts).

  • Following the submission of a Claim by Provider to Participating Payer or its Claims Administrator, Participating Payer or its Claims Administrator, based upon the existing Network Agreement (together with any other contractual conditions Provider may have agreed to with the Participating Payer or Network), shall Adjudicate the Claim, thereby determining the total amount due from the Participating Payer and the Covered Member for Covered Services rendered by Provider.

  • Payment of this amount to Provider shall be made by Participating Payer or its Claims Administrator as a Complete Payment.

  • Provider agrees that once the Complete Payment is made by the Participating Payer or its Claims Administrator, Simplicity owns the obligation and shall have the sole right to collect same.

  • Provider agrees to submit proper Claims to Participating Payer and to accurately account for any and all Covered Services provided to any Covered Member.

  • Provider agrees to accept the Complete Payment from a Participating Payer or its Claims Administrator, as payment in full for the total amount of the Claim.


More Definitions of Participating Payer

Participating Payer means a corporation, partnership, labor union, association, program, employer or any other entity responsible for the payment of Covered Services rendered to a Covered Member through a Participating Plan.
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Related to Participating Payer

  • Participating Party means an enterprise or public body that has committed itself to reaching certain objectives under a voluntary agreement, or is covered by a national regulatory policy instrument;

  • Participating FFI means an FFI that, as from the effective date of any rules requiring withholding on "passthru payments" (as such term is defined pursuant to Sections 1471 through 1474 of the Code and any regulations thereunder or official interpretations thereof), meets the requirements of Section 1471(b) of the Code and any regulations or other official guidance issued thereunder and that has not elected to be withheld upon pursuant to Section 1471(b)(3) of the Code.

  • Participating Country’ means any country that the Association determines meets the requirements set forth in Section 10 of Resolution No. 183 of the Board of Governors of the Association, adopted on June 26, 1996; and ‘Participating Countries’ means, collectively, all such countries.”

  • Participating Dentist means any Dentist who, at the time of rendering a Covered Dental Service to the Member, has a written agreement with CareFirst BlueChoice or the Dental Plan for the rendering of such service.

  • Participating provider means an Administrator Hospital or Professional Provider which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or an Administrator facility which has been designated by the Claim Administrator as a Participating Provider.

  • 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.

  • Participating physician means a physician licensed in Virginia to practice medicine, who practices

  • Participating student means a student in kindergarten through

  • Participating Share or “Share” means the Participating Shares of no par value in the

  • Non-Participating Orthotic Provider means an Orthotic 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 Pharmacy means a pharmacy that has entered into a prescription drug plan agreement with the Pharmacy Benefit Manager listed on your identification card.

  • Participating county means a county that has been authorized by the county governing body to enter into a contract with another local unit pursuant to section 4.

  • Non-Participating Provider means an Administrator Hospital or Professional Provider which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or a facility which has not been designated by the Claim Administrator as a Participating Provider.

  • Participating Bank means any participating banks of the JETCO ATM network, (if applicable) PLUS ATM network and/or (if applicable) China UnionPay ATM network;

  • Participating Account a separate account investing all or a portion of its assets in the Trust, including the Account.

  • 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 Broker- Dealer: See Section 2(b) hereof. Person: An individual, trustee, corporation, partnership, limited liability company, joint stock company, trust, unincorporated association, union, business association, firm or other legal entity. Private Exchange: See Section 2(b) hereof.

  • Participating Addendum is defined in Appendix A.

  • Participating employee means an employee whose election to participate in a Plan has been approved by the employer.

  • Participating Interest is defined in Section 1.2(d) hereof.

  • Participating Prosthetic Provider means a Prosthetic 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.

  • Participating Countries means, collectively, all such countries.”

  • Participating public employer means a public employer as defined in ORS 238.005 that

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

  • Participating Entity Any Subcontractor or Subservicer which is “participating in the servicing function” within the meaning of Item 1122 of Regulation AB; provided, further, for the purposes of the third paragraph of Section 7.04(c), that a “Participating Entity” shall be determined without respect to any threshold limitations in Instruction 2. to Item 1122 of Regulation AB. Person: Any individual, corporation, partnership, limited liability company, joint venture, association, joint-stock company, trust, unincorporated organization, government or any agency or political subdivision thereof.

  • Non-Participating Prosthetic Provider means a Prosthetic 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.