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.
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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.
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Payor Plan. Means the Medicaid STAR Program.
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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.

  • Written arrangements must specify that the performance of the parties is monitored by the Payor Plan on an ongoing basis and formally reviewed at least annually.

  • 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.

  • 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 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.

  • Provider hereby agrees to submit to ILS Community Network or Payor Plan, upon request, and in a timely manner, all information and/or data necessary for Payor Plan to fulfill these obligations, and within the timeframes specified by ILS Community Network or Payor Plan to meet CMS requirements.

  • 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.

  • ILS Community Network may terminate the Agreement immediately upon request of Payor Plan due to Provider's loss or suspension of licensure or certification, or sanction by Medicare or applicable Medicaid program.

  • 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.