Physicians or Designated Medical Group or IPA Sample Clauses

Physicians or Designated Medical Group or IPA. The child must be enrolled with Blue Shield to continue coverage beyond the first 31 days from the date of birth or placement for adoption. See the Eligibility and Enrollment section for additional information. Primary Care Physician Relationship The Physician-patient relationship is an important element of an HMO Plan. The Member’s Primary Care Physician will make every effort to ensure that all Medically Necessary and appropriate pro- fessional services are provided in a manner com- patible with the Member’s wishes. If the Member and Primary Care Physician fail to establish a sat- isfactory relationship or disagree on a recom- mended course of treatment, the Member may con- tact Shield Concierge at the number provided on the back page of this EOC for assistance in select- ing a new Primary Care Physician. If a Member is not able to establish a satisfactory relationship with his or her Primary Care Physician, Blue Shield will provide access to other available Primary Care Physicians. Role of the Primary Care Physician The Primary Care Physician chosen by the Mem- ber at the time of enrollment will coordinate all Covered Services including primary care, preven- tive services, routine health problems, consulta- tions with Plan Specialists (except as provided un- der Obstetrical/Gynecological Physician services, Trio+ Specialist, and Mental Health and Substance Use Disorder Services), Hospice admission through a Participating Hospice Agency, Emer- gency Services, Urgent Services and Hospital ad- mission. The Primary Care Physician will also manage prior authorization when needed. Because Physicians and other Health Care Providers set aside time for scheduled appoint- ments, the Member should notify the provider’s office within 24 hours if unable to keep an appoint- ment. Some offices may charge a fee (not to ex- ceed the Member’s Copayment or Coinsurance) unless the missed appointment was due to an emer- gency situation or 24-hour advance notice is pro- vided. Obstetrical/Gynecological (OB/GYN) Physician Services A female Member may arrange for obstetrical and/or gynecological (OB/GYN) Covered Ser- vices by an obstetrician/gynecologist or family practice Physician who is not her designated Pri- xxxx Care Physician without a referral from the Primary Care Physician or Medical Group/IPA. However, the obstetrician/gynecologist or family practice Physician must be in the same Medical Group/IPA as the Member’s Primary Care Physi- cian. Obstetrical and gynecologic...
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  • Services to the Corporation Agent will serve, at the will of the Corporation or under separate contract, if any such contract exists, as a director of the Corporation or as a director, officer or other fiduciary of an affiliate of the Corporation (including any employee benefit plan of the Corporation) faithfully and to the best of his ability so long as he is duly elected and qualified in accordance with the provisions of the Bylaws or other applicable charter documents of the Corporation or such affiliate; provided, however, that Agent may at any time and for any reason resign from such position (subject to any contractual obligation that Agent may have assumed apart from this Agreement) and that the Corporation or any affiliate shall have no obligation under this Agreement to continue Agent in any such position.

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  • Medical Services Plan 10.1.1 Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment.

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  • Medical Director The Contractor shall employ the services of a Medical Director who is a licensed Indiana Health Care Provider (IHCP) provider board certified in family medicine or internal medicine. If the Medical Director is not board certified in family medicine, they shall be supported by a clinical team with experience in pediatrics, behavioral health, adult medicine and obstetrics/gynecology. The Medical Director shall be dedicated full-time to the Contractor’s Indiana Medicaid product lines. The Medical Director shall oversee the development and implementation of the Contractor’s disease management, case management and care management programs; oversee the development of the Contractor’s clinical practice guidelines; review any potential quality of care problems; oversee the Contractor’s clinical management program and programs that address special needs populations; oversee health screenings; serve as the Contractor’s medical professional interface with the Contractor’s primary medical providers (PMPs) and specialty providers; and direct the Quality Management and Utilization Management programs, including, but not limited to, monitoring, corrective actions and other quality management, utilization management or program integrity activities. The Medical Director, in close coordination with other key staff, is responsible for ensuring that the medical management and quality management components of the Contractor’s operations are in compliance with the terms of the Contract. The Medical Director shall work closely with the Pharmacy Director to ensure compliance with pharmacy-related responsibilities set forth in Section 3.4. The Medical Director shall attend all OMPP quality meetings, including the Quality Strategy Committee meetings. If the Medical Director is unable to attend an OMPP quality meeting, the Medical Director shall designate a representative to take his or her place. Notwithstanding the Medical Director ‘s sending of a representative, the Medical Director shall be responsible for knowing and taking appropriate action on all agenda and action items from all OMPP quality meetings.

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  • Diagnostic Services Procedures ordered by a recognized Provider because of specific symptoms to diagnose a specific condition or disease. Some examples include, but are not limited to:

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