Covered Services definition

Covered Services means all or a part of those medical and health services set forth in rule 441—86.14(514I).

Covered Services means Medically Necessary health care items and services covered under a Benefit Plan.

Covered Services means those health care services for which Members are entitled to receive benefits, including reimbursement, under the terms of the applicable Plan.

Examples of Covered Services in a sentence

• Provider agrees to use commercially reasonable efforts to collect, and not to waive, any Copayments, Coinsurance and Deductibles for Covered Services.

• Provider understands that Crescent intends to enter into Crescent Network Access Agreements with Payors under which Crescent will be required to arrange certain Covered Services, including Provider Services, within the Service Area to Members of Plans sponsored or issued by the contracting Payors.

• Unless otherwise directed by Xxxxx or TPA, Provider may verify the current status of the Member’s eligibility for Covered Services by requesting the Member to present his or her identification card or by contacting Payor or Xxxxx’s designee during normal business hours.

• Provider agrees to cooperate with Crescent and Payor (or designee) and respond, at the requestor’s expense, to reasonable requests for information related to the provision of Covered Services by Provider.

• To the extent required by the applicable Crescent Network Access Agreement, Provider may only charge, bill and collect from a Member charges for healthcare services which are not Covered Services if the Member has signed a waiver acknowledging that such services were not authorized for reimbursement by Xxxxx and that the Member will pay such charges.

More Definitions of Covered Services

Covered Services means medically necessary mental health and substance abuse care as defined under the terms of the Program, except to the extent that such care is otherwise limited or excluded under the Program.

Covered Services means the services, supplies, or accommodations for which the Plan provides Benefits.

Covered Services means those health care services which are (i) identified as payable in Certificate(s), (ii) medically necessary as defined in such Certificates, and (iii) ordered and performed by a TRUST PRACTITIONER or other health care PRACTITIONER licensed to order and perform such services.

Covered Services means, except as otherwise provided in the Member’s benefit plan, a complete and routine eye examination including, but not limited to, visual acuities, internal and external examination, (including dilation where professionally indicated,) refraction, binocular function testing, tonometry, neurological integrity, biomicroscopy, keratometry, diagnosis and treatment plan, and when authorized by state law and covered by a Plan, medical eye care, diagnosis, treatment and eye care management services, and when applicable, ordering and dispensing plan eyeglasses from a DAVIS laboratory.

Covered Services means services for which reimbursement

Covered Services means those medical, surgical and related health care services which Practice and Participating Physicians provide to, or arrange for, Enrollees pursuant to a Health Benefit Plan and this Agreement.

Covered Services means the health and medical services described in Articles 2 and 11 of this Chapter as being eligible for reimbursement by AHCCCS.