Non-Network Provider definition

Non-Network Provider means any hospital, day care centre or other provider that is not part of the network.

Non-Network Provider means any hospital that is not part of the network.

Non-Network Provider means a practitioner or approved facility that has not entered into an agreement with OptumHealth to provide covered services to you.

Examples of Non-Network Provider in a sentence

• Specialized Provider A provider who is a Non-Network Provider but who also holds a health care professional license that is not the same type held by any Network Provider in the service area in which the services are rendered.

• If a pregnant Member in the third trimester of pregnancy has an established relationship with an obstetrical provider and desires to continue that relationship, and the provider is a Non-Network Provider, the CONTRACTOR shall reimburse the Non-Network Provider at the applicable Medicaid fee-for-service rate appropriate to the provider type.

• Non-Network Individual Deductible The Non-Network Individual Deductible applies to Covered Expenses charged by a Non-Network Provider.

• The term "Non-Network Provider" means a Provider that does not satisfy the definition of a Network Provider.

• Emergency Care is payable at the Network level, even if services are received from a Non-Network Provider.

More Definitions of Non-Network Provider

Non-Network Provider means an any individual, corporate entity, or any other organization that is engaged in the delivery of health care services, is legally authorized to do so by the State in which it delivers the services and who does not have a contract or any other pre-arranged payment or employment agreement with the Contractor.

Non-Network Provider means a medical practitioner, provider facility, or other provider who is NOT identified in the most current list for the network shown on your identification card. Services received from a non-network provider are not covered, except for:

Non-Network Provider means any physician, dentist, optometrist, anesthesiologist, hospital, x-ray, laboratory and ambulance service, or other person who:

Non-Network Provider means any hospital, day care centre or other provider that is not part of thenetwork

Non-Network Provider means an any individual, corporate entity, or any other organization that is engaged in the delivery of health care services, is legally authorized to do so by the State in which it delivers the services and who does not have a contract or any other pre-arranged payment or employment agreement with the Contractor. This was formerly referred to as Non- Participating Provider Notice of Adverse Benefit Determination means written notification to an Enrollee and written or verbal notification to a Provider when applicable, of an Adverse Benefit Determination that will be taken by the Contractor. This is formerly referred to as a Notice of Action. Notice of Appeal Resolution means written notification to an Enrollee, and a Provider when applicable, of the Contractor’s resolution of an Appeal. NQF means the National Quality Forum. Office of Recovery Services (ORS) means an agency within the Department of Human Services.

Non-Network Provider means any individual, corporate entity, or any other organization that is engaged in the delivery of health care services, is legally authorized to do so by the State in which it delivers the services and who does not have a contract or any other pre-arranged payment or employment agreement with the Contractor. Notice of Adverse Benefit Determination means written notification to an Enrollee and written or verbal notification to a Provider when applicable, of an Adverse Benefit Determination that will be taken by the Contractor. Notice of Appeal Resolution means written notification to an Enrollee, and a Provider when applicable, of the Contractor’s resolution of an Appeal. NQF means the National Quality Forum. Office of Recovery Services (ORS) means an agency within the Department of Human Services.

Non-Network Provider. Non-Network means any hospital, day care centre or other provider that is not part of the network.