Specialty Care Physician definition

Specialty Care Physician means a Preferred Provider Physician with any specialty other than primary care who practices such specialty and who has met the participation standards of the Company. (Specialty Care Physicians do not include the following: Family Practice, General Practice, Internal Medicine, Pediatrics or Obstetrics/Gynecology - when providing Preventive Health Services).
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Specialty Care Physician means a Participating Physician who is designated by the Network as a provider of specialty services other than primary care services.
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Specialty Care Physician means a Physician who: ------------------------
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Examples of Specialty Care Physician in a sentence

  • Benefits are provided when you obtain Covered Service from Providers; however, the broadest benefits are provided for services obtained from a Primary Care Physician (PCP), Specialty Care Physician (SCP), or other Network Providers.

  • Coverage is provided for the diagnosis and treatment of illness or Injury when provided in the medical office of the Specialty Care Physician.

  • Coverage for chiropractic services is subject to the Specialty Care Physician benefit listed in the Schedule of Benefits.

  • Network Provider means a health care provider duly licensed in the state in which they are practicing, including a Primary Care Physician, Specialty Care Physician, Hospital, laboratory, or other similar entity under a written contract with KPIC or KPIC’s contracted provider network as reflected in the provider directory.

  • Specialty Care Physician means a Physician in a board-certified specialty, other than those listed under the definition of Primary Care Physician.

  • The Coinsurance amount the Company will pay for the services listed below is one hundred percent (100%) of the Allowable Charge or the amount of the billed charge for the service whichever is less, subject to the Specialty Care Physician copayment amount listed in the Schedule of Benefits.

  • In addition, you should have your PCP or a Specialty Care Physician who is a Participating Provider request Covered Services.

  • In other words, if the network Primary Care Physician, Specialty Care Physician, or other provider recommends that services be received from another entity, it is Your responsibility to verify the network participation status of that entity before receiving such services.

  • The services must be rendered by the same Specialty Care Physician who provided face-to-face examination, evaluation or consult on the day of the services, and b.

  • We are not responsible for the accuracy or inaccuracy of network participation representations made by any PCP, Specialty Care Physician, Hospital, or other Provider whether contracted with Us or not.


More Definitions of Specialty Care Physician

Specialty Care Physician means a Participating Physician who has agreed to provide certain specialty health care services to Members.
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Related to Specialty Care Physician

  • Primary care physician means a physician who is a family

  • Medical physicist means a person trained in evaluating the performance of mammography equipment and facility quality assurance programs and who meets the qualifications for a medical physicist set forth in 41.6(3)“c.”

  • Specialist Physician means a licensed physician who qualifies as an attending physician and who examines a patient at the request of the attending physician or authorized nurse practitioner to aid in evaluation of disability, diagnosis, or provide temporary specialized treatment. A specialist physician may provide specialized treatment for the compensable injury or illness and give advice or an opinion regarding the treatment being rendered, or considered, for a patient’s compensable injury.

  • SPECIALTY HOSPITAL means a hospital or the specialty unit of a general hospital that is licensed by the state. It must be designed to care for patients with injuries or special illnesses. This includes, but is not limited to, a long-term acute care unit, an acute mental health or acute short-term rehabilitation unit or hospital. Hospital does not mean: • convalescent home; • rest home; • nursing home; • home for the aged; • school and college infirmary; • residential treatment facility; • long-term care facility; • urgent care center or freestanding ambulatory surgical center; • facility providing mainly custodial, educational or rehabilitative care; or • a section of a hospital used for custodial, educational or rehabilitative care, even if accredited by the JCAHO or listed in the AHA directory.

  • Pharmacy care means medications prescribed by a licensed physician and any health-related services considered medically necessary to determine the need or effectiveness of the medications.

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Authorized medical physicist means an individual who:

  • Hospice patient s family" means a hospice patient's immediate family members, including a spouse, brother, sister, child, or parent, and any other relative or individual who has significant personal ties to the patient and who is designated as a member of the patient's family by mutual agreement of the patient, the relative or individual, and the patient's interdisciplinary team.

  • Hospice means a public agency or private organization licensed pursuant to Chapter 400, Florida Statutes, to provide Hospice services. Such licensed entity must be principally engaged in providing pain relief, symptom management, and supportive services to terminally ill Members and their families.

  • Medical care means amounts paid for:

  • Outpatient hospital services means preventive, diagnostic, therapeutic, observation, rehabilitation, or palliative services provided to an outpatient by or under the direction of a physician, dentist, or other practitioner by an institution that:

  • Medical examination means the preliminary assessment of a person by an authorized health worker or by a person under the direct supervision of the competent authority, to determine the person’s health status and potential public health risk to others, and may include the scrutiny of health documents, and a physical examination when justified by the circumstances of the individual case;

  • Inpatient hospital services means any health care service provided to a patient who has been admitted to a hospital and is required to remain in that hospital overnight, but does not include any secure forensic mental health services;

  • Resident physician means a physician enrolled in an internship, residency or fellowship.

  • Health care services means services for the diagnosis, prevention, treatment, cure, or relief of a health condition, illness, injury, or disease.

  • Pharmacy means prescribed drugs and medicines dispensed by a pharmacist and/or travel and allergy vaccines dispensed by a pharmacist or doctor.

  • Hospital pharmacist means an Iowa-licensed pharmacist who meets the requirements for participating in a hospital practice protocol as determined by the hospital’s P&T committee.

  • Hospital services means the clinical services provided by the Hospital and the operational activities that support those clinical services, that are funded in whole or in part by the Funder, and includes the type, volume, frequency and availability of Hospital Services; HSAA Indicator Technical Specifications means the document entitled “HSAA Indicator Technical Specifications” as it may be amended or replaced from time to time;

  • Specialty means a broad, population-based focus of study encompassing the common health-related problems of a particular group of patients and the likely co-morbidities, interventions, and responses to those problems.

  • Orthodontic means a type of specialist dental treatment carried out by an orthodontist that diagnoses, prevents and corrects mispositioned teeth and jaws and misaligned bite patterns.

  • Primary care-giver means a person who assumes the principal role of providing care and attention to a child.

  • Hospital pharmacy means a pharmacy providing pharmaceutical care to

  • Licensed physician means a person licensed to practice

  • Hospital means a facility that:

  • Hospice services means palliative and supportive care and other services provided by an interdisciplinary team under the direction of an identifiable hospice administration to terminally ill hospice patients and their families to meet the physical, nutritional, emotional, social, spiritual, and special needs experienced during the final stages of illness, dying, and bereavement, as defined in Minnesota Statutes, § 144A.75, subd. 8, and includes the set of services as determined by the Medicare program under §1861(dd) of the Social Security Act and defined in 42 CFR § 418.3.