Payor Plan definition

Payor Plan means any benefit plan or program adopted, implemented, established, maintained or administered by a Payor for the purpose of providing, arranging for the provision of or making available health care services to participants in such plan or program.
Sample 1Sample 2
Payor Plan. Means the Medicaid STAR Program.
Sample 1
Payor Plan means any benefit plan or program adopted, implemented, established or by a Payor or Contract MCO for the purpose of providing, arranging for the provision of or making available Covered Services to Enrollees.
Sample 1

Examples of Payor Plan in a sentence

  • Provider shall gather and forward information on enrollee appeals to ILS Community Network or Payor Plan to the extent required by law or regulation so as to enable Payor Plan to meet the CMS required time frames for grievances and appeals.

  • Provider acknowledges that payment from applicable Managed Care Plan (hereinafter "Payor Plan") to ILS Community Network for services to Medicare Advantage, Medicaid and Reform Medicaid enrollees is derived in whole or in part from federal funds received by Payor Plan from CMS, and that Provider shall be subject to those laws, rules and regulations applicable to individuals and entities receiving federal funds.

  • Provider agrees to cooperate with any independent quality review and improvement organization utilized by or under contract with Payor Plan pertaining to the provision of services for Medicare Advantage, Medicaid and/or Reform Medicaid enrollees.

  • Provider further agrees to hold harmless and indemnify ILS Community Network and Payor Plan for any fines or penalties they may incur due to Provider's submission of inaccurate or incomplete data.

  • With respect to Medicare Advantage, Medicaid and Reform Medicaid patients, Provider acknowledges that Payor Plan is required by CMS to maintain a health information system that collects, analyzes and integrates all data necessary to compile, evaluate and report certain statistical data related to costs, utilization and quality, and such other matters as CMS may require from time to time.

  • To the extent that a Medicare Advantage, Medicaid or Reform Medicaid requirement is found in a policy, the Provider Handbook or other procedural guide of ILS Community Network and/or Payor Plan and is not otherwise specified in the Agreement, Provider will comply with those policies, manuals and procedures with regard to the provision of care to Medicare Advantage, Medicaid and/or Reform Medicaid enrollees.

  • Provider shall comply with applicable ILS Community Network and Payor Plan policies and, if requested by ILS Community Network, shall cooperate in developing and implementing medical policy, quality assurance programs, and medical management programs applied to Medicare Advantage Medicaid and/or Reform Medicaid enrollees.

  • It should be recalled that Article 4(4) of the LCR Delegated Regulation, in conjunction with Article 414 of the CRR, requires that, if the LCR falls or is reasonably expected to fall below 100% at any time, institutions immediately notify the relevant competent authority and submit a plan for the timely restoration of compliance with the LCR.

  • Payor Plan and ILS Community Network agree to provide all covered benefits to Medicare Advantage and, as applicable, Medicaid and Reform Medicaid enrollees in a manner consistent with professionally recognized standards of care.

  • Note: The Plan was created in section, “Create a Payor Plan (One Time Set-Up)” on page 6.

Related to Payor Plan

  • BCDR Plan means the plan consisting of general business continuity and disaster recovery principles, the Business Continuity Plan and Disaster Recovery Plan as further described in paragraph 1.2 of Schedule 2- 14.

  • Prior Plan means the coverage provided on a group or group-type basis by the group insurance policy, benefit plan or service plan that was terminated on the day before the Effective Date of the Plan and replaced by the Plan.

  • Flexi Plan means any individual indemnity hospital insurance plan under the VHIS framework with enhancement(s) to any or all of the protections or terms and benefits that the Standard Plan provides to the Policy Holder and the Insured Person, subject to certification by the Government. Such plan shall not contain terms and benefits which are less favourable than those in the Standard Plan, save for the exception as may be approved by the Government from time to time.

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Other Plan means any of the following plans, other than this Plan, providing benefits or services for medical or dental care or treatment:

  • Former Plan means any employee benefit plan in respect of which the Customer or a Subsidiary has engaged in a transaction described in Section 4069 or Section 4212(c) of ERISA.

  • Deferred Plan means a trust governed by a registered retirement savings plan, registered retirement income fund, registered education savings plan or tax-free savings account.

  • Nonqualified Deferred Compensation Rules means the limitations or requirements of Section 409A of the Code, as amended from time to time, including the guidance and regulations promulgated thereunder and successor provisions, guidance and regulations thereto.

  • Nonqualified deferred compensation plan means a compensation plan described in Section 3121(v)(2)(C) of the Internal Revenue Code.

  • Predecessor Plan means each of the Company’s 2005 Equity Incentive Plan, as amended, and the Enterasys Inc. 2013 Stock Plan, as amended.

  • Prior Plan Award means an award outstanding under the Prior Plan as of the Effective Date.

  • Alternate Payee means any spouse, former spouse, child, or other dependent of a Participant who is recognized by a qualified domestic relations order as having a right to receive all, or a portion of, the benefits payable under a Plan with respect to such Participant.

  • This Plan means, in a COB provision, the part of the contract providing the health care benefits to which the COB provision applies and which may be reduced because of the benefits of other plans. Any other part of the contract providing health care benefits is separate from this plan. A contract may apply one COB provision to certain benefits, such as dental benefits, coordinating only with similar benefits, and may apply another COB provision to coordinate other benefits.

  • Prior Plans means, collectively, the Company’s 2006 Long-Term Incentive Plan, as amended, 2009 Long-Term Incentive Plan, 2012 Long-Term Incentive Plan and 2013 Long-Term Incentive Plan. Awards granted under the Prior Plans continue to be governed under the terms of those Prior Plans.

  • DSU Plan means the Deferred Share Unit Plan of the Corporation.

  • Stock Plan means any stock incentive, stock option, stock ownership or employee benefits plan of the General Partner.

  • EHC plan means an Education, Health and Care plan made under sections 37(2) of the Children and Families Act 2014.

  • ESPP means the Company’s Employee Stock Purchase Plan.

  • Non-U.S. Plan means any plan, fund or other similar program that (a) is established or maintained outside the United States of America by the Company or any Subsidiary primarily for the benefit of employees of the Company or one or more Subsidiaries residing outside the United States of America, which plan, fund or other similar program provides, or results in, retirement income, a deferral of income in contemplation of retirement or payments to be made upon termination of employment, and (b) is not subject to ERISA or the Code.

  • Plan 3 means the teachers' retirement system, plan 3

  • Number of Students Who Began the Program means the number of students who began a program who were scheduled to complete the program within 100% of the published program length within the reporting calendar year and excludes all students who cancelled during the cancellation period.

  • Intended use plan or “IUP” means the program document identifying the intended uses of funds available for loans pursuant to the WPCSRF and the DWSRF.

  • 12b-1 PLAN With respect to any Fund that offers shares for which a Plan has been adopted under Rule 12b-1 (individually a "12b-1 Plan") of the Investment Company Act of 1940 (the "1940 Act"), you will be entitled to receive payments from the 12b-1 Plan fees for providing shareholder and administrative services to your customers who own Fund shares as set forth under the 12b-1 Plan(s) applicable to the Class or Classes of Fund shares purchased by your customers. Such shareholder and administrative services may include: answering inquiries regarding the Fund; assisting in changing dividend options, account designations and addresses; performing sub-accounting; establishing and maintaining shareholder accounts and records; processing purchase and redemption transactions; providing periodic statements and/or updates showing a customer's account balance and integrating such statements with those of other transactions and balances in the customer's other accounts serviced by you; and arranging for bank wires. You will transmit promptly to customers all communications sent to you for transmittal to customers by or on behalf of us, and the Fund or such Fund's investment advisor, custodian or transfer or dividend disbursing agent. You will promptly answer all written complaints received by you relating to Fund accounts or promptly forward such complaints to us and assist us in answering such complaints. For such services we will pay you a fee, as established by us from time to time, based on a portion of the net asset value of the accounts of your customers in the various Classes of the Fund. We are permitted to make this payment under the terms of the 12b-1 Plans adopted by certain of the Funds, as such Plans may be in effect from time to time. The 12b-1 Plans in effect on the date of this Agreement are described in the Funds' Prospectuses. Each Fund reserves the right to terminate or suspend its 12b-1 Plan at any time as specified in the Plan and we reserve the right, at any time, without notice, to modify, suspend or terminate payments hereunder in connection with such 12b-1 Plan. You will furnish the Fund and us with such information as may be reasonably requested by the Fund or its directors or trustees or by us with respect to such fees paid to you pursuant to this Agreement. You may request not to receive 12b-1 Plan fees. Any such request must be made to us in writing.

  • Restoration Plan means all technical and organisational measures necessary for the restoration of the system back to normal state;

  • Deferred Compensation Plan means any plan, agreement or arrangement maintained by the Company from time to time that provides opportunities for deferral of compensation.

  • Number of Students Who Began Program means the number of students who began the program who are scheduled to complete the program within the reporting calendar year.