Participating Provider Services Sample Clauses
Participating Provider Services. We pay [Your] Participating Providers for [Your][an Enrollee’s] Covered Health Services. You may be responsible for paying the Participating Provider for any applicable Copays, Coinsurance, or Deductibles included under this Contract. Please refer to the Schedule of Benefits for any applicable Deductible, Coinsurance or Copay information.
Participating Provider Services. The Participant agrees, and hereby represents that the Participating Providers have agreed, to furnish Covered Services to beneficiaries (“MSSP Enrollees”) assigned (including those MSSP Enrollees reflected as being preliminary prospective assignees), in accordance with the rules governing the MSSP, to the ACO that are within the Participating Provider’s licensing and qualifications. All Covered Services shall be provided in accordance with all applicable provisions of law, all applicable generally accepted professional standards, and the terms of this Agreement.
Participating Provider Services. Consistent with sound medical practice and accepted community professional standards for rendering quality medical care, Participating Provider will provide Covered Benefits to Members in accordance with the following:
(a) Participating Provider will provide Covered Benefits to Members within at least the same time period as provided to other patients. Participating Provider shall assist BCBSMT in monitoring Members’ care accessibility. Participating Provider agrees to comply with the following access to care standards:
i. A maximum wait time for routine-care appointment with a primary care provider of 45 days;
ii. A maximum wait time for urgent care with a primary provider of 2 days;
iii. A maximum wait time for routine-care appointment with a specialist of 60 days; and
iv. A maximum wait time for urgent care with a specialist of 4 days.
(b) Participating Provider shall not discriminate or refuse to accept any Member as a patient on the basis of race, color, religion, sex, age, national origin, health status, political ideas, marital status or medical condition/disability.