CHAMPUS TRICARE PROGRAM MEMBERS Clause Samples

CHAMPUS TRICARE PROGRAM MEMBERS. PPM agrees and shall require PPM Physicians to agree to care for CHAMPUS Members, and active duty military personnel, without discrimination and in the same manner as care provided to PPM Physicians' other patients. PPM further agrees and shall require PPM Physicians to further agree to comply with all CHAMPUS managed care support policies and procedures and to become CHAMPUS certified. Such CHAMPUS policies and procedures are set forth in the Provider Handbook which is hereby incorporated by reference and made a part of this Agreement. PPM agrees and shall require PPM Physicians to agree to be a member of the HUMANA CHAMPUS Network. PPM Physicians licensed in Family Practice, Internal Medicine and/or Pediatrics are considered Primary Care Managers, (P.C.M.). P.C.M. responsibilities are outlined in the Provider Handbook. PPM agrees and shall require PPM Physicians to agree that medical records related to CHAMPUS Members, and active duty military personnel, under PPM Physicians care shall include a release which designates the Military Hospital Commander, or the referring primary care physician, as the receiving part of the medical record, upon proper request. As of the effective date of this Agreement, PPM agrees and shall require PPM Physicians to agree to accept NOT APPLICABLE percent (N/A%) of CHAMPUS Maximum Fee Schedule, less any applicable Copayment, deductible, or cost-share amount due from the CHAMPUS Member, as payment in full for Covered Services provided to CHAMPUS Members, and active duty military personnel. Further, PPM agrees and shall require PPM Physicians to agree to accept Medicare assignment, less any applicable Copayments, deductibles, and/or cost-share amounts due from CHAMPUS eligible Members for Covered Services provided to CHAMPUS eligible - Members who are also Medicare eligible. 50 PHYSICIAN PRACTICE MANAGEMENT PARTICIPATION AGREEMENT ATTACHMENT E (con't) Notwithstanding the above, PPM agrees and shall require PPM Physicians to agree that in no event shall payment made for health care services provided to CHAMPUS Members, and active duty military personnel, exceed Not Applicable percent (N/A%) of any CHAMPUS allowable (e.g., DRG, CMAC, or outpatient charges). PHYSICIAN PRACTICE MANAGEMENT PARTICIPATION AGREEMENT EXHIBIT E-1 COMMERCIAL CAPITATION TABLES * * This Exhibit E-1 to Attachment E (which consists of 11 pages) of this Agreement has been so omitted pursuant to a request for confidential treatment and has been filed separatel...