Provider in the same or similar specialty definition

Provider in the same or similar specialty means the practice specialty of a provider, as identified by the plan or issuer consistent with the plan’s or issuer’s usual business practice, except that, with respect to air ambulance services, all providers of air ambulance services are considered to be a single provider specialty.
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Examples of Provider in the same or similar specialty in a sentence

  • Qualified Payment Amount means the median of the contracted rates recognized by the Plan, or recognized by all plans serviced by the Plan’s claims administrator, for the same or similar item of service provided by a Provider in the same or similar specialty in the same geographic region.

  • A Participating Provider may also request a second opinion in regard to covered Services by referring you to another Participating Provider in the same or similar specialty.

  • The committee receives a written report from a licensed physician or other appropriate Health Care Provider in the same or similar specialty that typically manages or consults on the service/item in question.

  • The goal of these organizations during these incidents is to provide a coordinated response to mitigate impacts on public health.

  • If the Appeal of an Adverse Determination is denied and, within ten (10) working days from the denial, Your Provider sets forth in writing good cause for having a particular type of specialty Provider review the case, the Appeal denial will be reviewed by a Participating Provider in the same or similar specialty that typically manages the medical, dental or specialty condition, procedure, or treatment under discussion for review of the Adverse Determination.

  • If the Appeal of an Adverse Determination is denied and, within ten (10) working days from the denial, the Appeal denial will be reviewed by a Participating Provider in the same or similar specialty that typically manages the medical, dental or specialty condition, procedure, or treatment under discussion for review of the Adverse Determination.

  • The Qualifying Payment Amount will be based on the median of the contracted rate for the same or similar item or service provided by a Provider in the same or similar specialty in the same geographic region.

  • Qualifying Payment Amount is the median of the contracted rates recognized by the Plan, or recognized by all plans serviced by the Plan’s Third Party Administrator (if calculated by the Third Party Administrator), for the same or a similar item or service provided by a Provider in the same or similar specialty in the same geographic region.

Related to Provider in the same or similar specialty

  • Provider Organization means a group practice, facility, or organization that is:

  • Health care organization ’ means any person or en-

  • Automotive windshield washer fluid means any liquid designed for use in a motor vehicle windshield washer system either as an antifreeze or for the purpose of cleaning, washing, or wetting the windshield. Automotive windshield washer fluid does not include fluids placed by the manufacturer in a new vehicle.

  • Participating Home Infusion Therapy Provider means a Home Infusion Therapy Provider who has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Established geographic service area means a geographic area, as approved by the Commissioner and based on the carrier's certificate of authority to transact insurance in this state, within which the carrier is authorized to provide coverage;

  • Non-Participating Home Infusion Therapy Provider means a Home Infusion Therapy Provider who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Expansion to an existing manufactured home park or subdivision means the preparation of additional sites by the construction of facilities for servicing the lots on which the manufactured homes are to be affixed (including the installation of utilities, the construction of streets, and either final site grading or the pouring of concrete pads).

  • Automotive hard paste wax means an automotive wax or polish that is:

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

  • Extended foster care services means residential and other

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Health service area or “HSA” refers to the distinct geographic regions described in Section 4.1.4 or the Vermont Blueprint for Health Manual.

  • Specified anatomical areas means and includes:

  • Electric Reliability Organization or “ERO” means the organization that is certified by the Commission under Section 39.3 of its regulations, the purpose of which is to establish and enforce Reliability Standards for the Bulk Power System in the United States, subject to Commission review. The organization may also have received recognition by Applicable Governmental Authorities in Canada and Mexico to establish and enforce Reliability Standards for the Bulk Power Systems of the respective countries.

  • Nonambulatory means a person who immediately and without the aid of another is not physically and mentally capable of traveling a normal path to safety, including the ascent and descent of stairs.

  • Existing manufactured home park or subdivision means a manufactured home park or subdivision for which the construction of facilities for servicing the lots on which the manufactured homes are to be affixed (including, at a minimum, the installation of utilities, the construction of streets, and either final site grading or the pouring of concrete pads) is completed before the effective date of the floodplain management regulations adopted by a community.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Mobile telecommunications service means the same as that term is defined in Section 124(7) of Public Law 106-252 (Mobile Telecommunications Sourcing Act).

  • Automotive Wax, Polish, Sealant or Glaze means a product designed to seal out moisture, increase gloss, or otherwise enhance a motor vehicle’s painted surfaces. “Automotive Wax, Polish, Sealant or Glaze” includes, but is not limited to, products designed for use in autobody repair shops and “drive-through” car washes, as well as products designed for the general public. “Automotive Wax, Polish, Sealant or Glaze” does not include “Automotive Rubbing or Polishing Compounds”, automotive wash and wax products, surfactant-containing car wash products, and products designed for use on unpainted surfaces such as bare metal, chrome, glass, or plastic.

  • Designated chemical dependency specialist means a person

  • National Flood Insurance Program means the program created by the U.S. Congress pursuant to the National Flood Insurance Act of 1968 and the Flood Disaster Protection Act of 1973, as revised by the National Flood Insurance Reform Act of 1994, that mandates the purchase of flood insurance to cover real property improvements located in Special Flood Hazard Areas in participating communities and provides protection to property owners through a Federal insurance program.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Anatomical gift means a donation of all or part of a human body to take effect after the donor's death for the purpose of transplantation, therapy, research, or education.

  • Licensed assistant behavior analyst means a person who holds current certification as a Board Certified Assistant Behavior Analyst issued by the Behavior Analyst Certification Board, Inc., or any successor in interest to that organization, who is licensed as an assistant behavior analyst by the Aging and Disability Services Division of the Department of Health and Human Services and who provides behavioral therapy under the supervision of a licensed behavior analyst or psychologist.

  • Floodplain or flood-prone area means any land area susceptible to being inundated by water from any source (see definition of “flood”).

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.