An individual who is authorized by a Provider to accept the PROVIDERnet Terms & Conditions, register for a PROVIDERnet account, use the PROVIDERnet website and submit Claims, in each case on behalf of Provider.

Examples:

• Multi-disciplinary Clinic: Office Manager, Owner, Front Desk (if applicable)
• Individual Practitioner Clinic: Practitioner

A request for reimbursement of the Eligible Expense portion of an expense submitted on behalf of a Member.

A charge incurred by a Member for Services or Equipment covered under a Policy as a benefit.

Equipment, products or supplies purchased by a Provider on behalf of a Member or by a Member from a Provider.

Any service that directly relates to acquiring, delivering or using Equipment.

Money paid to a Provider in connection with a Claim that was not to reimburse an Eligible Expense as determined by Pacific Blue Cross or in connection with a Claim arising from or related to a breach of the PROVIDERnet Terms & Conditions.

An individual, group or government funded benefit contract insured or administered by Pacific Blue Cross.

An individual who is licensed or registered in accordance with Applicable Laws to provide certain services to the public, and who is registered with, or in the process of being registered with, Pacific Blue Cross to provide Practitioner Services.

Examples: Dr Jane Doe DC; John Doe RMT, Jo Doe ND

Any services provided directly by a Practitioner to one Member.

A Person who registers for a PROVIDERnet account and who receives or will receive payments in respect of Claims for Eligible Expenses from Pacific Blue Cross on behalf of Members, and for greater certainty a Provider who is an individual may also be a Practitioner.

Equipment Services and Practitioner Services.