Payer Plan definition

Payer Plan means a program agreed upon pursuant to a Payer Agreement by IPA and a Payer that includes a panel of Participating Providers selected by IPA and/or Payer to provide Covered Services.
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Payer Plan. Agreements shall mean those certain agreements between (i) TMHC and/or Provider, and (ii) Payers that describe the terms and conditions for the provision of Covered Services to Covered Persons by TMHC and/or Provider in accordance with each Payer's Payer Plan.
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Examples of Payer Plan in a sentence

  • Provider shall exercise reasonable efforts in following the procedures for transfer of Members as set forth in the Payer Plan.

  • Except for Emergency Care, Provider shall verify with the applicable Payer Plan the eligibility of a Member before admitting or providing Covered Services to such Member.

  • Provider shall not request, demand, require or otherwise seek, directly or indirectly, the termination from a Payer Plan of any Medicare Member based upon the Medicare Member’s need for or utilization of medically required services, or in order to gain financially or otherwise from such termination.

  • For purposes of this Section 6.11.2, “Audit” shall be defined as an instance in which HPN or Payer acknowledges coverage of a Member under a Payer Plan but additional information is required to pay a claim, in whole or in part.

  • Provider agrees that Covered Services to be provided under this Agreement will be compensated by HPN only on proper referral by a PCP, unless the Payer Plan specifically authorizes Provider to provide Covered Services other than through referral by a PCP.

  • Provider shall cooperate and participate in all HPN and Payer Plan requirements designed to ensure that there is a confidential exchange of information among Participating Providers.

  • An initial Brand Plan for each Product will be approved by the JSC not later than three (3) months after initiation of the first Phase 3 Trial for such Product; provided, that the initial Global Payer Plan and each initial Access and Pricing Plan will be approved by the JSC at such times as the JSC so determines.

  • HPN may terminate Provider’s participation, in whole or in part, under a Payer Plan in the event the contract between CMS and a Payer or the Payer Agreement between HPN and a Payer is terminated or not renewed.

  • Provider will provide Covered Services to Members in accordance with the terms set forth in this Agreement, the applicable Payer Agreement, and the applicable Payer Plan, in the same manner, in accordance with the same standards, and within the same time availability, as provided to Provider’s non-Member patients.

  • Provider agrees to comply with the quality management and improvement program of each Payer Plan and to consult with HPN and Payer regarding such activities.