Delegation of Provider Selection Sample Clauses

Delegation of Provider Selection. As applicable, Provider understands that if selection of providers who render services to Managed Care Plan Enrollees has been delegated to ILS Community Network and/or Provider by Managed Care Plan, either expressly or impliedly, then Managed Care Plan retains the right to approve, suspend or terminate such downstream or subcontracted arrangements. [42 C.F.R. § 422.504 (i) (5).]
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Delegation of Provider Selection. As applicable, Provider understands that if selection of providers who render services to Medicare beneficiaries has been delegated to First Tier Entity by Health Plan, either expressly or impliedly, then Health Plan retains the right to approve, suspend or terminate such downstream or subcontracted arrangements to the extent applicable to Medicare beneficiaries enrolled with Health Plan. [42 C.F .R. § 422.504(i)( 5).]
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Delegation of Provider Selection. Where applicable, in instances where practitioner selects providers related to the rendering of care to Group Health Cooperative managed care members, Group Health Cooperative retains the right to approve, suspend, or terminate such arrangement as required under 422.504(i)(5).
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Delegation of Provider Selection. In addition to the responsibilities for delegated activities as set forth herein, to the extent that Plan has delegated selection of providers, contractors, or subcontractor to Provider, Plan retains the right to approve, suspend, or terminate any such arrangement.
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Delegation of Provider Selection. In addition to the responsibilities as set forth in section 12.4 above, to the extent that Plan has delegated selection of the providers, contractors, or subcontractor to Provider, the Plan retains the right to approve, suspend, or terminate any such arrangement. HEALTH CARE PROVIDER SUMMARY DISCLOSURE FORM Anthem Blue Cross and Blue Shield (Anthem) HMO Colorado, Inc. (HMOC) Provider Name: Board of Commissioner of Ouray County on behalf of its Public Health Agency TIN: 00-0000000 Date: May 28, 2015 I. Compensation and PaymentFee for Service  Reimbursement: Indemnity: The lesser of billed charges or 100% of the Medicare RBRVS fee schedule. PPO: The lesser of billed charges or 100 % of the Medicare RBRVS fee schedule. HMO: The lesser of billed charges or 100% of the Medicare RBRVS fee schedule. Medicare Advantage: 100% of the current Medicare fee schedule % of the current Medicare fee schedule  For information on the Medicare RBRVS Physician fee schedule, please visit xxxx://xxx.xxx.xxx.xxx/PhysicianFeeSched/. NPs and PAs: Anthem shall reimburse NP/PA Provider the lesser of billed charges or 100% of the Medicare RBRVS fee schedule Anthem BCBS has implemented for Covered ServicesBeginning July 1, 2015, Anthem’s physician fee schedule is based on the January 2014 Medicare fee schedule. Anthem applies the Colorado Geographic Practice Cost Indexes (GPCIs) to the RVUs and utilizes Site of Service differentials. The Medicare conversion factor that Anthem is using for 2014 is 35.82 instead of 35.8228. The Medicare RVUs are rounded from four (4) decimal points to two (2) decimal points. ● For information on the Medicare fee schedule, please visit xxxx://xxx.xxx.xxx.xxx/PhysicianFeeSched/. ● Immunizations are paid 100% of AWP (Average Wholesale Price); Non-Immunizations with a CMS XXX, 000% of ASP; as of 01/01/10: Non-Immunizations with no CMS ASP, 85% of AWP. A flat fee table for ASP (Average Sell Price) Drugs, updated from time to time, is available at the CMS website at: xxxx://xxx.xxx.xxx.xxx/McrPartBDrugAvgSalesPrice/. Anthem uses XxxxxxxxxxxxxXxxxx.xxx for AWP. The following services’ reimbursement rates are located in Plan Compensation Schedule Attachment – of your contract. ● DME and supplies ● Lab services/codes done in the office ● Therapy Codes (97001-97799) ● Radiology codes ● Sleep Studies (in-office) ● Allergy Immunotherapy : CPT code 95165 ● Non-Invasive Vascular Diagnostic Studies: CPT Codes 93880 – 93990 ● Allergy Testing: CPT Codes 95004 – 9...
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Delegation of Provider Selection. Where applicable, in instances where practitioner selects providers related to the rendering of care to KFHPWA managed care members, KFHPWA retains the right to approve, suspend, or terminate such arrangement as required under 422.504(i)(5).
Sample 1
Delegation of Provider Selection. In addition to the responsibilities as set forth in section 12.4 above, to the extent that Plan has delegated selection of the providers, contractors, or subcontractor to Provider, the Plan retains the right to approve, suspend, or terminate any such arrangement. WORKERS' COMPENSATION PARTICIPATION ATTACHMENT TO THE ANTHEM BLUE CROSS AND BLUE SHIELD PROVIDER AGREEMENT This is a Participation Attachment to the Anthem Blue Cross Provider Agreement ("Agreement"), entered into by and between Anthem and Provider and is incorporated into the Agreement.
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Related to Delegation of Provider Selection

  • Adoption of Procedures State Street and each Fund may from time to time adopt such procedures as they agree upon, and State Street may conclusively assume that no procedure approved or directed by a Fund, a Fund’s or Portfolio’s accountants or other advisors conflicts with or violates any requirements of the prospectus, articles of incorporation, bylaws, declaration of trust, any applicable law, rule or regulation, or any order, decree or agreement by which the Fund may be bound. Each Fund will be responsible for notifying State Street of any changes in statutes, regulations, rules, requirements or policies which may impact State Street responsibilities or procedures under this Agreement.

  • Delegation of Services The Administrator may, at its expense, delegate to one or more entities some or all of the services for the Fund for which the Administrator is responsible under this Subcontract. The Administrator will be responsible for the compensation, if any, of any such entities for such services to the Fund, unless otherwise agreed to by the parties or with the Fund. Notwithstanding any delegation pursuant to this paragraph, the Administrator will continue to have responsibility and liability for all such services provided to the Fund under this Subcontract.

  • Delegation of Board Review of Subcustodians From time to time, the Custodian may agree to perform certain reviews of Subcustodians and of Subcustodian Contracts as delegate of the Fund's Board. In such event, the Custodian's duties and obligations with respect to this delegated review will be performed in accordance with the terms of the attached 17f-5 Delegation Schedule to this Agreement.

  • BINDING EFFECT; DELEGATION OF DUTIES PROHIBITED This Agreement shall inure to the benefit of, and shall be binding upon, the parties hereto and their respective successors, assigns, heirs, and legal representatives, including any entity with which the Employer may merge or consolidate or to which all or substantially all of its assets may be transferred. The duties and covenants of the Executive under this Agreement, being personal, may not be delegated.

  • Limitation on Resignation of Master Servicer The Master Servicer shall not resign from the obligations and duties hereby imposed on it except (a) upon appointment of a successor servicer and receipt by the Trustee of a letter from each Rating Agency that such a resignation and appointment will not result in a downgrading of the rating of any of the Certificates, or (b) upon determination that its duties hereunder are no longer permissible under applicable law. Any such determination under clause (b) permitting the resignation of the Master Servicer shall be evidenced by an Opinion of Counsel to such effect delivered to the Trustee. No such resignation shall become effective until the Trustee or a successor master servicer shall have assumed the Master Servicer's responsibilities, duties, liabilities and obligations hereunder.

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