Delegated Entity definition

Delegated Entity means an entity, other than a health maintenance organization authorized to engage in business under Chapter 843, that by itself, or through subcontracts with one or more entities, undertakes to arrange for or provide medical care or health care to an enrollee in exchange for a predetermined payment on a prospective basis and that accepts responsibility for performing on behalf of the health maintenance organization a function regulated by this chapter, Chapter 222, 251, or 258, as applicable to a health maintenance organization, Chapter 843 or 1271, Section 1367.053, Subchapter A, Chapter 1452, or Subchapter B, Chapter 1507. The term does not include:
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Delegated Entity means any party that enters into an agreement with Plan to provide administrative services or health care services to qualified individuals, qualified employers, or qualified employees and their dependents. Provider is a Delegated Entity.
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Delegated Entity means any party, including an agent or broker, that enters into an agreement with Health Plan to provide administrative services or health care services to qualified individuals, qualified employers or qualified employees and their dependents (as such terms are defined in 45 C.F.R. §156.20).
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Examples of Delegated Entity in a sentence

  • Licensor shall be liable to Licensee for all acts and omissions of any Delegated Entity in performing any duties hereunder.

  • Delegated Entity means any party, including an agent or broker, that enters into an agreement with a QHP issuer to provide administrative services or health care services to qualified individuals, qualified employers, or qualified employees and their dependents.

  • To the extent it deems practicable, Company shall endeavor to include in contracts entered into with Delegated Entities subsequent to the Implementation Date terms that are substantially equivalent to the terms of this Agreement; provided that Company shall not be liable hereunder in the event any Delegated Entity acts in a manner inconsistent with the terms of this Agreement.

  • No such subcontract, delegation or assignment to any Delegated Entity shall relieve Licensor of responsibility for the due and full performance hereof.

  • In the event that Agent uses a subcontractor to perform any of Agent’s obligations as a Delegated Entity, Agent shall enter into an agreement with such subcontractor that includes a provision that the subcontractor agrees to be bound by the same terms and conditions that apply to Agent under this Agreement with respect to such delegated obligations.


More Definitions of Delegated Entity

Delegated Entity means a unit or single organization authorized by written agreement to act on behalf of the insurer to provide managed care services.
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Delegated Entity means a filer that another filer authorizes on the dashboard to file on its behalf. As itself a filer, a delegated entity is subject to all applicable rules for filing on EDGAR. Delegated entities are not permitted to further delegate authority to file for the delegating filer, nor are they permitted to take action on the delegating filer’s dashboard.
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Delegated Entity. - means a local government (or other governmental entity such as a tribal
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Delegated Entity means a First Tier Entity with whom HPSM has contracted to perform specified delegated functions on HPSM’s behalf in accordance with state, local, and federal laws, rules, and guidelines, as well as in accordance with HPSM policies and procedures.
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Delegated Entity means (a) a full service licensed health plan with which it is reasonably necessary for Company to contract because Company does not have reasonable capacity to provide specialty services or administer coverage in the geographic areas served by such health plan; and (b) an entity that is not an Affiliate of Company to the extent that such entity (i) maintains its own contracts with Physicians separate from any contracts between Company and Physicians, and, (ii) by agreement with Company, (A) agrees to provide Plan Members with access to such Physicians pursuant to terms of such agreements; and
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Delegated Entity means an entity that is not a Subsidiary of CIGNA HealthCare to the extent that such entity (i) maintains its own contracts with Physicians separate from any contracts between CIGNA HealthCare and Physicians, and, by agreement with CIGNA HealthCare, (ii) (A) agrees to provide CIGNA HealthCare Members with access to such Physicians pursuant to the terms of such agreements; and (B) performs some or all of the functions with respect to Plans which otherwise would be performed by CIGNA HealthCare, including without limitation claims adjudication, utilization review, utilization management and credentialing.
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Delegated Entity or “Delegated Provider” means a risk bearing organization as defined in Health and Safety Code section 1375.4, that when applicable, is financially responsible for Covered Services provided by Provider and the entity to whom Provider shall seek payment from for those delegated Covered Services.
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