Common use of Provider Services Function Clause in Contracts

Provider Services Function. (A) The Contractor shall operate Provider Services function during regular business hours. (B) At a minimum, Provider Services staff shall be responsible for the following: (1) training, including ongoing training, of the Contractor’s Providers on CHIP rules and regulations that shall enable Providers to appropriately render services to Enrollees; (2) assisting Providers to verify whether an individual is enrolled with the Dental Plan; (3) assisting Providers with prior authorizations and referral protocols; (4) assisting Providers with claims payment procedures; and (5) ▇▇▇▇▇▇▇▇ and responding to Provider questions and the Grievance and Appeals System.

Provider Services Function. (A) The Contractor shall operate Provider Services function during regular business hours. (B) At a minimum, Provider Services staff shall be responsible for the following: (1) training, including ongoing training, of the Contractor’s Providers on CHIP rules and regulations that shall enable Providers to appropriately render services to Enrollees; (2) assisting Providers to verify whether an individual is enrolled with the Dental Contractor’s Health Plan; (3) assisting Providers with prior authorizations and referral protocols; (4) assisting Providers with claims payment procedures; and (5) ▇▇▇▇▇▇▇▇ and responding to Provider questions and the Grievance and Appeals System.