Common use of Program Exceptions Clause in Contracts

Program Exceptions. The PH-MCO is required to establish a Program Exception process, reviewed and approved by the Department, whereby a Provider may request coverage for items or services, which are included in the Member’s benefit package but are not currently listed on the MA Program Fee Schedule. The PH-MCO must also apply the program exception process to requests to exceed limits for items or services that are on the Fee Schedule if the limits are not based in statute or regulation. These requests are recognized by the Department as a Program Exception and are described in 55 Pa. Code §1150.63.

Program Exceptions. The PH-MCO is also required to establish a Program Exception process, reviewed and approved by the Department, whereby a Provider may request coverage for items or services, which are while included in under the MemberRecipient’s benefit package but package, are not currently listed on the MA Program Fee Schedule. The PH-MCO must also apply In addition to requests for items or services that are not on the MA fee schedule, the program exception process must be applied to requests to exceed limits for items or services that are on the Fee Schedule fee schedule if the limits are not based in statute or regulation. These requests are recognized by the Department as a Program Exception and are described in 55 Pa. Code §1150.63.

Program Exceptions. ‌ The PH-MCO is also required to establish a Program Exception process, reviewed and approved by the Department, whereby a Provider may request coverage for items or services, which are while included in under the MemberRecipient’s benefit package but package, are not currently listed on the MA Program Fee Schedule. The PH-MCO must also apply In addition to requests for items or services that are not on the MA fee schedule, the program exception process must be applied to requests to exceed limits for items or services that are on the Fee Schedule fee schedule if the limits are not based in statute or regulation. These requests are recognized by the Department as a Program Exception and are described in 55 Pa. Code §1150.63.

Program Exceptions. ‌ The PH-MCO is required to establish a Program Exception process, reviewed and approved by the Department, whereby a Provider may request coverage for items or services, which are included in the Member’s benefit package but are not currently listed on the MA Program Fee Schedule. The PH-MCO must also apply the program exception process to requests to exceed limits for items or services that are on the Fee Schedule if the limits are not based in statute or regulation. These requests are recognized by the Department as a Program Exception and are described in 55 Pa. Code §1150.63.

Program Exceptions. The PH-MCO is required to establish a Program Exception process, reviewed and approved by the Department, whereby a Provider may request coverage for items or services, which are included in the Member’s 's benefit package but are not currently listed on the MA Program Fee Schedule. The PH-MCO must also apply the program exception process to requests to exceed limits for items or services that are on the Fee Schedule if the limits are not based in statute or regulation. These requests are recognized by the Department as a Program Exception and are described in 55 Pa. Code §1150.63.