Provider Referrals. Except as permitted by the Member’s Evidence of Coverage, Provider shall not refer a Blue Shield Member to other health care providers without an advance authorization from Blue Shield or its delegate or otherwise in accordance with the utilization management procedures established by Blue Shield and as described in the Provider Manual. Without limiting the foregoing, if this Agreement applies to Blue Shield commercial HMO, EPO and/or Medicare Advantage Benefit Programs, Provider shall refer commercial HMO, EPO and/or Medicare Advantage Members only to health care providers who/that have entered into agreements with Blue Shield to provide Covered Services to Members for the provision of Covered Services. This provision shall not apply in the event a Member requires Emergency Services.
Provider Referrals. In an effort to assist USA in developing a comprehensive network, providing for a full continuum of care, please provide a name and number for those entities you commonly refer patients to: Services Provided Ancillary/Hospital/Provider Name & Address Contact Name Telephone No. ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Contact Sheet For (Facility Name) The following person(s) will be the USA’s contact(s) for the above named facility. CONTRACTING: Name: Title: E-mail Address: Telephone Number: ( ) Fax Number: ( ) FACILITY UPDATES: Name: Title: E-mail Address: Telephone Number: ( ) Fax Number: ( ) CEO / PRESIDENT / DIRECTOR Name: Title: E-mail Address: Telephone Number: ( ) Fax Number: ( )
Provider Referrals. In an effort to assist USA in developing a comprehensive network, providing for a full continuum of care, please provide a name and number for those entities you commonly refer patients to: Services Provided Ancillary/Hospital/Provider Name & Address Contact Name Telephone No. ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) Contact Sheet For (Facility Name) The following person(s) will be the USA’s contact(s) for the above named facility.
Provider Referrals. Except as permitted by the Member’s Evidence of Coverage, Provider shall not refer a Member to other health care providers without an advance Authorization from Health Plan or its delegate or otherwise in accordance with the utilization management procedures established by Health Plan and as described in the Provider Manual. Without limiting the foregoing, if this Agreement applies to Health Plan commercial HMO, EPO and/or Medicare Advantage Benefit Programs, Provider shall refer commercial HMO, EPO and/or Medicare Advantage Members only to health care providers who/that have entered into agreements with Health Plan to provide Covered Services to Members for the provision of Covered Services. This provision shall not apply in the event a Member requires Emergency Services.
