Precertification and Referrals Clause Samples
Precertification and Referrals. Except when a Member requires emergency services, Hospital agrees to comply with any applicable precertification and/or referral requirements under the Member's Plan prior to the provision of Hospital services. Hospital will utilize the electronic real time HIPAA compliant transactions, including but not limited to, eligibility, precertification and claim status inquiry transactions. Hospital agrees to provide notice of all admissions of Members, and of all services for which Company requires notice, upon admission or prior to the provision of such services. For the purpose of pre-admission testing, Hospital agrees to directly provide testing or accept test results and examinations performed outside Hospital, provided such tests and examinations are: (a) performed by a state licensed laboratory for laboratory tests, and a licensed physician for such other tests and examinations; and (b) performed within a time reasonably proximate to the admission. For those Members who require services under a specialty program, Hospital agrees to work with Company in transferring the Member's care to a specialty program Hospital, as the case may be.
Precertification and Referrals. Except when a Member requires emergency services, Facility agrees to comply with any applicable precertification and/or referral requirements under the Member's Plan prior to the provision of Facility services. Facility will utilize the electronic real time HIPAA compliant transactions, including but not limited to, eligibility, precertification and claim status inquiry transactions. Facility agrees to provide notice of all admissions of Members, and of all services for which Company requires notice, upon admission or prior to the provision of such services. For the purpose of pre-admission testing, Facility agrees to directly provide testing or accept test results and examinations performed outside Facility, provided such tests and examinations are: (a) performed by a state licensed laboratory for laboratory tests, and a licensed physician for such other tests and examinations; and (b) performed within a time reasonably proximate to the admission. For those Members who require services under a specialty program, Facility agrees to work with Company in transferring the Member's care to a specialty program Facility, as the case may be.
Precertification and Referrals. Service Provider agrees that it will and will require all Network Providers to comply with any applicable precertification, site of care and/or referral requirements under the Member’s Plan and Company Policies. For the purpose of applicable pre-service testing, if any, Service Provider agrees to require Network Providers to directly provide testing or accept outside test results and examination, provided such tests and examinations are: (a) performed by a state licensed laboratory for laboratory tests, and a licensed physician for such other tests and examinations; and (b) performed within a time reasonably proximate to the delivery of services. For those Members who require services under a specialty program, Service Provider agrees that it will and will require Network Providers to work with Company in transferring the Member’s care to a specialty program provider.