Coordinated Care. Provider shall participate in the CMO’s programs designed to facilitate the coordination of all medically necessary Covered Services, including both physical and behavioral health healthcare services, as well as other non-medical services that a Member may be receiving or be in need of receiving. Subject to medical judgment, patient care interests, and a patient’s express instructions, and recognizing that the level of Covered Services provided by Provider may be affected by the Provider’s scope of services, Provider shall abide by all applicable laws and regulations, the State Contract and all Care Select Program and CMO requirements governing the referral of Members. For Addendum for Care Select Program Primary Medical Provider Members requiring hospitalization, Provider shall abide by all applicable CMO policies and procedures and all State Contract, Program and CMO utilization review requirements.
Coordinated Care. A. Hospitalizationsfor clients in coordinated care will be tracked and reported on an annual basis. No more than 18% will be hospitalized during the contract year.
Coordinated Care. Your primary care physician will coordinate your health care and refer you to other BlueCHiP providers when necessary. Only your primary care physician may refer you to other BlueCHiP providers. For example if your primary care physician refers you to a specialist, that specialist may not refer you to another specialist. In that case you would have to get a referral to the second specialist from your primary care physician. PERMITTED SELF-REFERRALS: You may self-refer to the following BlueCHiP providers for covered health care services: Behavioral Health Services; Early Intervention Services*; Emergency Care (Emergency Room Services, Ambulance Services, and free-standing Emergency Medical Centers); Hair Prosthetics (Wigs)* Hearing Aids* Obstetricians and Gynecologists; Oncologists – Office Visits (consultation or second opinion; all other services require a referral); Optometrists; Oral Surgery; Pediatric Dental Services; Retail Clinics; and Telemedicine services (rendered by a designated provider. See Section 3.36 for details). * You may also self-refer to a non-network provider for covered health care services for Early Intervention Services, Hair Prosthetics, and Hearing Aids.
Coordinated Care. Is the service provided to Enrollees by doctors who are part of the preferred network of providers in your Primary Medical Group. The PCP is the leading provider of services and is responsible to periodically evaluate your health and coordinate all medical services you need.
