Participating Provider Organization definition

Participating Provider Organization means a group practice, facility, or organization that has a contractual relationship with an MCE and is on the MCE’s panel and;
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Participating Provider Organization means a group practice, facility, or organiz. A Participating Provider is not a Subcontractor solely by virtue of a Participating Provider agreement with an MCE. "Network Provider" has the same meaning as Participating Provider.¶
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Participating Provider Organization means a group practice, facility, or organization that has a
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Examples of Participating Provider Organization in a sentence

  • To minimize out-of-pocket costs, it is important that the Insured Person receive services from a Participating Provider Organization.

  • Covered Expenses rendered by a non- participating provider may cost the Insured Person more than Covered Expenses rendered by a Participating Provider Organization.

  • Benefits will be paid at 80% of the Allowable Amount for services rendered by Network Providers in BCBSIL Participating Provider Organization PPO Network, unless otherwise specified in the Policy.

  • Services obtained from Out- of-Network Providers (any provider outside the BCBSIL Participating Provider Organization PPO Network) will be paid at 50% of the Allowable Amount, unless otherwise specified in the Policy.

  • Services obtained from Out- of-Network Providers (any provider outside the BCBSIL Participating Provider Organization PPO Network) will be paid at 60% of the Allowable Amount, unless otherwise specified in the Policy.

  • The Plan is a plan which contains a Participating Provider Organization.

  • If I do not have private insurance, I am required by the Student Accident Insurance program to see a medical provider (Doctor Clinic or Hospital) who is an Anthem Blue Cross Participating Provider Organization (PPO).

  • ENROLLMENT PERIODS Initial Enrollment Period When you are eligible for coverage in the Company's Group Health Care Plan, you have the option to enroll in the Participating Provider Organization (PPO) Plan.Annual Open Enrollment Period Every November during the annual open enrollment period, eligible Employees and their eligible Dependents will be able to change some of their benefit decisions based on which benefits and coverages are right for them.

  • The PPO network is BCBSIL Participating Provider Organization (PPO) Network.

  • Participating Provider Organization (PPO)/Indemnity plans contract with health care providers who agree to accept a negotiated lower payment from the health plan, with copayments from the subscribers, as payment in full for medical services.

Related to Participating Provider Organization

  • Provider Organization means a group practice, facility, or organization that is:

  • Preferred Provider Organization or "PPO" means an entity through which a group of health care providers, such as doctors, hospitals and others, agree to provide specific medical and hospital care and some related services at a negotiated price.

  • 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 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.

  • 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 network, but provides health care services to enrollees of programs authorized under this chapter or other applicable law whose health care services are provided by the managed health care system.

  • 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.

  • 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.

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other entity administering the Medicaid program and a health care operation under which the health care operation agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • 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.

  • Health care organization ’ means any person or en-

  • Participating Organization means an organization which elects to offer coverage under a Policy by completing a participation agreement that has been accepted by the Company.

  • 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.

  • 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.

  • 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.

  • 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).

  • Participating Prescription Drug Provider means an independent retail Pharmacy, chain of retail Pharmacies, mail-order Pharmacy or specialty drug Pharmacy which has entered into an agreement to provide pharmaceutical services to participants in the benefit program. A retail Participating Pharmacy may or may not be a select Participating Pharmacy as that term is used in the Vaccinations Obtained Through Participating Pharmacies section.

  • 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.

  • Member organization means any individual, corporation, limited liability company, partnership, or association that belongs to an association.

  • Local Service Provider (LSP means the LEC that provides retail local Exchange Service to an End User. The LSP may or may not provide any physical network components to support the provision of that End User’s service.

  • Provider agreement means the signed, written, contractual agreement between the department and the provider of services or goods.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Professional employer organization means an employee leasing

  • 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.

  • Religious organization means a church, ecclesiastical corporation, or group, not organized for pecuniary profit, that gathers for mutual support and edification in piety or worship of a supreme deity.

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.