Provider Network Services Sample Clauses
Provider Network Services. The PIHP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. The PIHP remains the accountable party for the Medicaid beneficiaries in its service area, regardless of the functions it has delegated to its CSSNs and its provider networks. In this regard, the PIHP agrees to:
A. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter;
B. Have clearly written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes.
C. Provide a copy of the PIHP's prior authorization policies to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to prior authorization policies as changes are made.
D. Provide a copy of the PIHP's grievance, appeal and fair hearing procedures and timeframes to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to those procedures or timeframes.
E. Provide to MDCH in the format specified by MDCH, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area.
F. Notify MDCH within seven (7) days of any changes to the composition of the provider network organizations. PIHPs shall have procedures to address changes in its network that negatively affect access to care. Changes in provider network composition that MDCH determines to negatively affect recipient access to covered services may be grounds for sanctions.
G. Assure that the provider network responds to the cultural, racial, and linguistic needs (including interpretive services as necessary) of the service area, and make oral interpretation services available free of charge to each potential beneficiary. This applies to all non-English languages not just those that the State identifies as prevalent. Each entity must notify its beneficiaries how to access oral interpretation services.
H. Assure that services are accessible, taking into account travel time, availability of public transportation, and other factors that may determine accessibility.
I. Assure that network providers do not segregate PIHP individuals in any way from other peop...
Provider Network Services. The CMHSP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. In this regard, the CMHSP agrees to:
A. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter.
B. Have clear written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes.
▇. Provide a copy of the CMHSP's prior authorization policies to the provider when the provider joins the CMHSP's provider network. The CMHSP must notify providers of any changes to prior authorization policies as changes are made.
D. Provide to the MDHHS in the format specified by the MDHHS, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area.
Provider Network Services. The PIHP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. The PIHP remains the accountable party for the Medicaid beneficiaries in its service area, regardless of the functions it has delegated to its provider networks. In this regard and in compliance with 42 CFR Parts 438.414; 438.10(g)(2)(xi)(C)(D)(E) and 457.1260, the PIHP agrees to:
1. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter.
2. Have clearly written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes.
3. Provide a copy of the PIHP's prior authorization policies to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to prior authorization policies as changes are made.
4. Provide a copy of the PIHP's grievance, appeal and fair hearing procedures and timeframes to the provider when the provider joins the PIHP's provider network. The PIHP must notify providers of any changes to those procedures or timeframes. Please see attachment P6.
3.1.1 GA Technical Requirement for Grievance & Appeal timeframes and State Fair Hearing process for further detail.
5. Provide to MDHHS in the format specified by MDHHS, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area.
6. Assure that services are accessible, taking into account travel time, availability of public transportation, and other factors that may determine accessibility.
7. Assure that network providers do not segregate PIHP individuals in any way from other people receiving their services. In addition, the PIHP agrees upon request from MDHHS either through an RFP or other means to:
1. Provide documentation on which the state bases its certification that the MCP complied with the state’s requirements for availability and accessibility of services, including the adequacy of the provider network as referenced in 42 CFR Parts 438.604(a)(5); 438.606; 438.207(b) and 438.206.
2. Submit any other data, documentation, or information relating to the performance of the entity’s obligations as required by the state or Secretary as referenced in...
Provider Network Services. The CMHSP is responsible for maintaining and continually evaluating an effective provider network adequate to fulfill the obligations of this contract. In this regard, the CMHSP agrees to:
A. Maintain a regular means of communicating and providing information on changes in policies and procedures to its providers. This may include guidelines for answering written correspondence to providers, offering provider-dedicated phone lines, and a regular provider newsletter.
B. Have clear written mechanisms to address provider grievances and complaints, and an appeal system to resolve disputes.
C. Provide a copy of the CMHSP's prior authorization policies to the provider when the provider joins the CMHSP's provider network. The CMHSP must notify providers of any changes to prior authorization policies as changes are made.
D. Provide to the MDCH in the format specified by the MDCH, provider agency information profiles that contain a complete listing and description of the provider network available to recipients in the service area.
E. Notify MDCH within seven (7) days of any changes to the composition of the provider network organizations. CMHSPs shall have procedures to address changes in its network that negatively affect access to care. Changes in provider network organization and/or composition that the MDCH determines to negatively affect the CMHSP's ability to meet its service obligations under MCL 330.1206(1) to priority populations (MCL 330.1208) may be grounds for sanctions.
F. Assure that the provider network responds to the cultural, racial and linguistic needs (including interpretive services as necessary) of the service area.
G. Assure that services are accessible, taking into account travel time, availability of public transportation, and other factors that may determine accessibility.
H. Assure that network providers do not segregate the CMHSP's recipients in any way from other people receiving their services.
I. The CMHSP shall assure HIPAA compliant access to information about persons receiving services in their contractual residential settings by individuals who have completed training and are working under the auspices of the Dignified Lifestyles Community Connections program.
Provider Network Services. BCBSNC shall make available to Members a network of Participating Providers. BCBSNC shall credential each Participating Provider in accordance with the procedures and guidelines attached hereto as Exhibit H. BCBSNC may also make available to Members one or more Participating Blue Plans; however, BCBSNC shall not be responsible for credentialing the Providers in the participating Blue Plans. The Plan Sponsor and the Plan Administrator understand, acknowledge and agree that (i) BCBSNC does not render medical services or treatment to Members; (ii) BCBSNC is not responsible for the health care that is delivered by Providers to Members; (iii) Providers are solely responsible for the health care they deliver to Members; (iv) the provision of health care services by Providers to Members is subject to the rules, practices and procedures of such Providers; (v) Providers are not employed by BCBSNC and are not agents or partners of BCBSNC; (vi) BCBSNC assumes no obligation other than those set forth in this Agreement, and (vii) BCBSNC is not responsible for any action of omission or commission by any Provider or its employees in rendering or failing to render health care services to Members.
Provider Network Services