Benefits Services Sample Clauses

Benefits Services. Benefits services are comprised of the following services:

Benefits Services. The CONTRACTOR shall be required to provide a comprehensive coordinated and fully integrated system of health care services. The CONTRACTOR does not have the option of deleting benefits from the Medicaid defined benefit package. Behavioral health services provided by the CONTRACTOR’S network providers will be covered by the CONTRACTOR even when the primary diagnosis is a behavioral health diagnosis. Facility costs, including emergency room costs, will be covered by the CONTRACTOR unless there is a specific psychiatric revenue code on the facility claim form. Any professional services provided by a behavioral health provider in an emergency room or in an inpatient or outpatient hospital setting will be covered by the SE. Any services provided by a physical health provider in an emergency room or in an inpatient setting will be covered by the CONTRACTOR. The SE will cover outpatient hospital services that require the use of a psychiatrist or psychological revenue code for billing the services. Pharmacy claims prescribed by a physical health provider will be covered by the CONTRACTOR. The following services are included in the covered benefit package of this Agreement:

Benefits Services. 3.4 Confidential Information 6.1 Customary Billing 3.1 Employee Welfare Plans 4.2 Financial Support Arrangements 6.3(a) force majeure 7.5 Limited Indemnified Person 4.3 Pass-Through Billing 3.1 Payment Date 3.5 Prior Agreements 7.1 Service Costs 3.1 The Limited Preamble The Limited Plans 3.4

Benefits Services. The CONTRACTOR shall be required to provide a comprehensive, coordinated and fully integrated system of health care services. The CONTRACTOR does not have the option of deleting access to benefits from the Medicaid defined benefit package. Access to Medicaid benefits must be available for physical health services directly by the CONTRACTOR’S network or with respect to behavioral health services through the CONTRACTOR’S referral and coordination system to the Statewide Entity. Behavioral health services provided by the CONTRACTOR’S network providers will be covered by the CONTRACTOR even when the primary diagnosis is a behavioral health diagnosis. Facility costs, including emergency room costs, will be covered by the CONTRACTOR when billed on an acute care/general hospital facility claim form, including behavioral health services provided by hospital staff. Laboratory and Radiology Services The lab and radiology costs shall be the responsibility of the MCO when a BH provider orders lab or radiology work that is performed by an outside, independent laboratory or radiology facility, including those lab and radiology services provided for persons within a psychiatric unit, a freestanding psychiatric hospital or the UNM Psychiatric emergency room. Lab and radiology services shall be the responsibility of the SE when they are provided within and billed by a free standing psychiatric hospital, a PPS exempt unit of a general acute care hospital or UNM Psychiatric ER. In the event that a psychiatrist orders lab work but completes that lab work in their office/facility and bills for it, the SE is responsible for the payment. The following services are included in the covered benefit package of this Agreement:

Benefits Services. TRANSITION SERVICES AGREEMENT SCHEDULE A -------------------------------------------------------------------------------- Seller agrees to continue all benefits coverage for Transferred Employees through December 31, 2002, to the extent that such coverage would not normally be continued through the end of the month. TRANSITION SERVICES AGREEMENT SCHEDULE A -------------------------------------------------------------------------------- 1. ANNEXES ANNEX 1 TO SCHEDULE A USA - SERVICES AND CHARGES

Benefits Services. 3.04 Confidential Information 6.01 Customary Billing 3.01 Employee Welfare Plans 4.02 Financial Support Arrangements 6.03(a) force majeure 7.05 Limited Indemnified Person 4.03 Pass-Through Billing 3.01 Payment Date 3.05