Participating Provider means an Administrator Hospital or Professional Provider which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to participants in the Participating Provider Option program or an Administrator facility which has been designated by the Claim Administrator as a Participating Provider.
Participating Provider means a Plan Hospital or Professional Provider which has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield Plan to provide services to partici pants in a Participating Provider Option program or a Plan facility or Professional Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider.
Participating Provider means a provider who, under a contract with the health carrier or with its contractor or subcontractor, has agreed to provide health care services to covered persons with an expectation of receiving payment, other than coinsurance, copayments or deductibles, directly or indirectly from the health carrier.
Examples of Participating Provider in a sentence
Home Health Care We will pay for up to forty visits per calendar year for home health care provided by a certifed home health agency that is a Participating Provider.
Member Services: 1-800-223-7242, TTY: 711 Crisis Line: 1-800-223-7242, TTY: 711 When New Members Are In a Course of Treatment If you are in a course of treatment with a non- Participating Provider when you enroll with us, you may be able to receive care from the non- Participating Provider for up to 60 days from the date you become covered under this Contract.
If you need ongoing specialty care, you may receive a “standing referral,” to a specialist who is a Participating Provider.
Except in an emergency, the prescription must be issued by a Participating Provider and flled at a Participating Pharmacy.
However, in order for you to continue care for up to 90 days or through a pregnancy with a former Participating Provider, the provider must agree to accept our payment and adhere to our procedures and policies, including those for assuring quality of care.
More Definitions of Participating Provider
Participating Provider means a Hospital or Professional Provider that either: (i) has a written agreement with Blue Cross and Blue Shield of Illinois or another Blue Cross and/or Blue Shield to provide services to participants in the benefit program, or; (ii) has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider in the benefit program.
Participating Provider. A Provider who has a contract with Us to provide health care services to You. A list of Participating Providers and their locations is available on Our website at xxx.xxxxxx.xxx or upon Your request to Us. The list will be revised from time to time by Us. Physician or Physician Services: Health care services a licensed medical Physician (M.D. – Medical Doctor or D.O. – Doctor of Osteopathic Medicine) provides or coordinates. Plan Year: A calendar year ending on December 31 of each year. Preauthorization: A decision by Us prior to Your receipt of a Covered Service, procedure, treatment plan, or device that the Covered Service, procedure, treatment plan, or device is Medically Necessary. We indicate which Covered Services require Preauthorization in the Schedule of Benefits section of this Contract. Premium: The amount that must be paid for Your dental insurance coverage. Premium Tax Credit: Financial help that lowers Your taxes to help You and Your family pay for private dental insurance. You can get this help if You get health insurance through the NYSOH and Your income is below a certain level. Advance payments of the tax credit can be used right away to lower Your monthly Premium. Primary Care Dentist (“PCD”): A participating dentist who directly provides or coordinates a range of dental services for You. Provider: An appropriately licensed, registered or certified dentist, dental hygienist, or dental assistant under Title 8 of the New York State Education Law (or other comparable state law, if applicable) that the New York State Insurance Law requires to be recognized who charges and bills patients for Covered Services. The Provider’s services must be rendered within the lawful scope of practice for that type of Provider in order to be Covered under the Contract. Referral: An authorization given to one Participating Provider from another Participating Provider (usually from a PCD to a Specialist) in order to arrange for additional care for a Member. A Referral can be transmitted electronically or by Your Provider completing a paper Referral form.
Participating Provider means a provider of health or behavioral health care and/or services that has a Provider Agreement with the Contractor.
Participating Provider means, with respect to a particular Product, any physician, hospital, ancillary, or other health care provider that has contracted, directly or indirectly, with Health Plan to provide Covered Services to Covered Persons, that has been approved for participation by Company, and that is designated by Company as a “participating provider” in such Product.
Participating Provider means, for purposes of this Amendment only, with respect to a Covered Service, a facility, physician or other health care provider who has a contractual relationship with BCBSMT setting a rate (above which the provider cannot bill the member) for furnishing such item or service under the Contract to which this Amendment is attached regardless whether the provider is considered a preferred or in-network provider for purposes of in-network or out-of-network benefits under the subject Contract.
Participating Provider means a health care
Participating Provider means a provider that has a contractual relationship with an MCE and is on their panel of providers.