Plan Provider Manual definition

Plan Provider Manual means the CarePlus Health Plans, Inc. Provider Manual, as amended and revised from time to time by Plan in its discretion.
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Plan Provider Manual means the HealthSun Health Plans Provider Manual, as amended and revised from time to time by Plan, and provided to MSO.
Sample 1
Plan Provider Manual refers to policies, procedures, programs and protocols adopted by Plan to be used by PO or Participating Provider in providing services and doing business with Plan under this Agreement, including but not limited to credentialing and re - credentialing verification processes, utilization management, quality improvement, peer review, Member grievance process or concurrent review. Pursuant to N.C. Gen. Stat. § 58- 50-285, in the event of a conflict between the Plan Provider Manual and this Contract, the Contract shall prevail.
Sample 1

Examples of Plan Provider Manual in a sentence

  • Additionally, Provider agrees to comply with the MA Plan Provider Manual and all policies and procedures relating to MA Benefit Plans.

  • This version of the L.A. Care Health Plan Provider Manual has been created specifically for the care of L.A. Care’s Cal MediConnect members.

  • This Plan Provider Manual (“PPM”) is intended to be a guideline for the provision of Covered Services to Vitality’s Medicare beneficiaries.

  • This version of the L.A. Care Health Plan Provider Manual has been created specifically for the care of L.A. Care’s MA-SNP members.

  • Network Provider shall comply with all billing and reporting procedures established by Plan as set forth in the Agreement or the Attachments and Schedules hereto and in the Plan Provider Manual.

  • The Agreement, this Acknowledgement, and the Health Plan Provider Manual constitute the entire Agreement between Health Plan, Provider, and Practitioner.

  • The provider complies with all provisions of the corresponding section in the service-specific performance specifications for each level of care for which they are contracted.2. The provider complies with the staffing requirements of the applicable licensing body, the staffing requirements in the Plan service-specific performance specifications, and the credentialing criteria outlined in the Plan Provider Manual, Volume I, as referenced at providerexpress.com.

  • All Services rendered and payment for same under this Agreement shall comply with the BABHA Prepaid Inpatient Health Plan Provider Manual (“Provider Manual”), and BABHA Policies and Procedures as applicable to Provider, and the MDHHS Provider Qualifications, accessible at xxx.xxxxx.xxx/XxxxxxxxXxxxxxxxxxx.xxxx and incorporated hereto by reference.

  • This Non-Traditional Medicaid Plan Provider Manual describes only the limitations and reduced benefits under NTM.

  • Additionally, Provider agrees to comply with the Medicare Advantage Plan Provider Manual and all policies and procedures relating to the Benefit Plans.

Related to Plan Provider Manual

  • Provider Manual means a working document, including but not limited to BCBSM published bulletins and provider notices, that provide specific guidelines and direction by which providers may meet their contractual responsibility as described in this Agreement. Provider Manuals are published on web-DENIS.

  • Program Manual means the United States Department of Agriculture, Animal and Plant Health Inspection Service, Plant Protection and Quarantine, Gypsy Moth Program Manual, 1994 edition.

  • User Manual means the user guide, Help Guide, documentation provided with the Software, updated agreements provided on the website of Quick Heal (xxx.xxxxxxxxx.xxx), explanatory or other materials as provided from time to time by Quick Heal.

  • Project Manual means the volume usually assembled for the Work which may include the bidding requirements, sample forms, and other Contract Documents.

  • Project Implementation Manual or “PIM” means the manual setting out the measures required for the implementation of the Project, as the same may be amended from time to time, subject to prior approval of the Association;

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

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

  • Web Site Accessibility Standards/Specifications means standards contained in Title 1 Texas Administrative Code Chapter 206.

  • Procedures Manual means the standards and procedures manual described in Section 11.3.

  • Quality Assurance Program means the overall quality program and associated activities including the Department’s Quality Assurance, Design-Builder Quality Control, the Contract’s quality requirements for design and construction to assure compliance with Department Specifications and procedures.

  • Diagnostic clinical procedures manual means a collection of written procedures that describes each method (and other instructions and precautions) by which the licensee performs diagnostic clinical procedures; where each diagnostic clinical procedure has been approved by the authorized user and includes the radiopharmaceutical, dosage, and route of administration.

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

  • Operations Manual means a manual containing procedures, instructions and guidance for use by operational personnel in the execution of their duties;

  • Service Provider Materials means all works of authorship, products and materials [including, but not limited to, data, diagrams, charts, reports, specifications, studies, inventions, software, software development tools, methodologies, ideas, methods, processes, concepts and techniques] owned by, or licensed to, the Service Provider prior to the Commencement Date or independently developed by the Service Provider outside the scope of this Agreement at no expense to Transnet, and used by the Service Provider in the performance of the Services;

  • Service Level Agreement or SLA means the processes, deliverables, key performance indicators and performance standards relating to the Services to be provided by the Service Provider;

  • Service Terms means the rights and restrictions for particular Services located at xxxx://xxx.xxxxxx.xxx/serviceterms (and any successor or related locations designated by us), as may be updated by us from time to time.

  • New jobs training program or “program” means the project or projects established by a community college for the creation of jobs by providing education and training of workers for new jobs for new or expanding industry in the merged area served by the community college. The proceeds of the certificates, as authorized by the Act, shall be used only to fund program services related to training programs made necessary by the creation of new jobs.

  • 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.

  • Design Manual means the MOHLTC design manual or manuals in effect and applicable to the development, upgrade, retrofit, renovation or redevelopment of the Home or Beds subject to this Agreement.

  • MERS Procedures Manual The MERS Procedures Manual, as it may be amended, supplemented or otherwise modified from time to time.

  • Training program means an NCA-approved Iowa college, the Iowa law enforcement academy or an Iowa hospital approved by the department to conduct emergency medical care training.

  • Electronic and Information Resources Accessibility Standards means the accessibility standards for electronic and information resources contained in 1 Texas Administrative Code Chapter 213.

  • Web Site Accessibility Standards/Specifications means standards contained in Title 1 Texas Administrative Code Chapter 206.

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

  • Enhanced Service Provider (ESP means the provider of enhanced services, as those services are defined in 47 CFR Section 64.702.