Payer Agreement definition

Payer Agreement means a contract between a Payer and a Participant and/or Provider/Supplier which sets forth the health care benefits a Covered Person is entitled to receive and the terms and conditions upon which the Payer will pay the Participant and/or Provider/Supplier in connection with the provision of Covered Services. The term Payer Agreement includes all coverage, payment and other requirements applicable to the Medicare program, Parts A and B, but it does not include Program Agreements.

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Payer Agreement means a contract between a Payer and a Participant that sets forth the health care benefits a covered person is entitled to receive and the terms and conditions upon which the Payer will pay the Participant for the provision of covered health care services.

Payer Agreement means an agreement between HASO on behalf of a Network Provider and a Payer that specifies the rights and obligations of Payer and a Network Provider, respectively, regarding the provision of Covered Services by Network Providers to Members who are eligible under applicable Plans to receive Covered Services.

Examples of Payer Agreement in a sentence

You must also immediately notify CIN in the event of suspension or other termination of any such Payer Agreement.
Except as expressly agreed in writing by CIN, each Payer has full and final responsibility and liability for payment of claims under an applicable Payer Agreement.
You agree to provide to Covered Persons those Covered Services that Your Providers are licensed and credentialed to provide in compliance with this Agreement and an applicable Payer Agreement, and to provide such Covered Services in accordance with the same standards and in the same manner as Your other patients.
If You do not elect to terminate this Agreement, any Payer Agreement negotiated by CIN will supersede any individual Payer Agreements You have previously entered into with the designated Payer.
Provider agrees that Provider’s failure to submit claims within the time required by HPN or the applicable Payer Agreement may result in disallowance , of reimbursement for purposes of payment unless such failure on Provider’s part was with good cause, as determined under the applicable Payer Agreement.
The completed 835 ERA Enrollment & Payer Agreement Document should be faxed to ▇▇▇-▇▇▇-▇▇▇▇ or After the 835 ERA Enrollment & Payer Agreement Document is processed, our EDI Team will send an email notification to the Trading Partner and the Pay-To provider regarding enrollment completion.
Provider shall have fifteen (15) business days from receipt of a Notice of Existing Payer Agreements or Notice of Future Payer Agreements to provide HPN with written notice (the “Notice of Exception”) in the event Provider is unable to effectuate the parties’ understanding under this Section 2.21 with respect to a Payer Agreement serving as the Primary Agreement when there is one or more Payer Agreements that cover the same subject matter as this Agreement.
Notwithstanding termination of this Agreement, HPN and Payer shall continue to have access to the records maintained by Provider in accordance with Section 9.1 for a period of six (6) years from the date of the provision of the Covered Services to Members to which the records refer for purposes consistent with their rights, duties and obligations under this Agreement and Payer Agreement.
By executing this Agreement, You agree to, and represent and warrant that each of Your Providers agrees to, perform CIN Activities and to be bound by and comply with this Agreement, CIN Policies, the applicable Payer Agreement and Provider Manuals, and Performance Standards, as applicable to each Commercial Program Agreement in which You are designated to participate.
Claims must be submitted in the form specified in the applicable Payer Agreement and in accordance with HPN’s requirements of a Clean Claim as stated in Exhibit E to this Amendment.

More Definitions of Payer Agreement

Payer Agreement means the contract between a Payer and IPA.

Payer Agreement means an agreement with a Payer and KHF (and thus the Network) setting forth the terms and conditions under which the Network shall arrange for the provision of Covered Services to Members under Plan(s) specifically referenced in such Payer Agreement.