PROVISION OF MEDICAL SERVICES Clause Samples
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PROVISION OF MEDICAL SERVICES. Medical Practice recognizes and acknowledges that Practice Manager will incur substantial costs in providing office, equipment, support services, personnel, marketing, management, administration, and other items and services that are the subject matter of this Agreement. The parties also recognize that the services to be provided by Practice Manager will be feasible only if Medical Practice operates an active practice to which the Physicians associated with Medical Practice devote their full time and attention. Medical Practice shall use its best efforts to obtain and enforce formal agreements from its shareholders and physician employees pursuant to which the Physicians agree to devote their full time and attention to the practice of medicine as described herein.
PROVISION OF MEDICAL SERVICES. Group shall perform, or subcontract to perform as necessary, all medically necessary services for Patients in accordance with the terms of Group Agreements and subject to the utilization review protocols. All subcontracts shall be negotiated and executed by Manager on behalf of Group.
PROVISION OF MEDICAL SERVICES. IPA shall provide Members all available medical services within the normal scope of and in accordance with IPA’s: (a) licenses and certifications, and (b) privileges to provide certain services based upon IPA’s qualifications as determined by Humana. IPA agrees to comply with all requests for information related to IPA’s qualifications in connection with Humana’s determination whether to extend privileges to provide certain services and/or procedures to Members. IPA shall not b▇▇▇, charge, seek payment or have any recourse against Humana or Members for any amounts related to the provision of Physician Services for which Humana has notified IPA that privileges to perform such services have not been extended.
PROVISION OF MEDICAL SERVICES. 9.1 Physician shall provide Members all available health care services within the normal scope of and in accordance with Physician's licenses and certifications. Physician agrees to comply with all requests for information related to Physician’s qualifications in connection with VHP's determination whether to extend privileges to provide certain services and/or procedures to Members. Physician shall not ▇▇▇▇, charge, seek payment or have any recourse against VHP or Members for any amounts related to the provision of health care services for which VHP has notified Physician that privileges to perform such services have not been extended.
9.2 VHP prohibits pass-through billing. Pass through billing occurs when the ordering Physician requests and bills for a service, but the service is not performed by the ordering Physician or those under their direct employment. Physician agrees that services related to pass-through billing will not be eligible for reimbursement from VHP and Physician shall not ▇▇▇▇, charge, seek payment or have any recourse against VHP or Members for any amounts related to the provision of pass-through billing.
PROVISION OF MEDICAL SERVICES. The Team Member acknowledges and agrees that: the Team Member remains primarily responsible for the Team Member’s own health care; the Team Member shall obtain and maintain their own health insurance coverage; MAI may, at its absolute discretion, offer to provide certain additional medical services using Team designated Health Care Providers; and MAI will not meet the cost of medical services provided to the Team Member by non-Team Health Care Providers.
PROVISION OF MEDICAL SERVICES. The Practice shall perform, or ----------------------------- subcontract to perform as necessary, all medically necessary services for patients, including managed care patients, in accordance with the terms of managed care agreements and subject to the utilization review protocols. All subcontracts shall be reviewed by MidSouth prior to their execution.
PROVISION OF MEDICAL SERVICES. 9.1 Physician shall provide Members all available medical services within the normal scope of and in accordance with Physician’s: (a) licenses and certifications, and (b) privileges to provide certain services based upon Physician’s qualifications as determined by Humana. Physician agrees to comply with all requests for information related to Physician’s qualifications in connection with Humana’s determination whether to extend privileges to provide certain services and/or procedures to Members. Physician shall not bill, charge, seek payment or have any recourse against Humana or Members for any amounts related to the provision of Physician Services for which Humana has notified Physician that privileges to perform such services have not been extended.
9.2 Physician shall maintain all office medical equipment including, but not limited to, imaging, diagnostic and/or therapeutic equipment (hereinafter referred to as “Equipment”) in acceptable working order and condition and in accordance with the Equipment manufacturer’s recommendations for scheduled service and maintenance. Such Equipment shall be located in Physician’s office locations that promote patient and employee safety. Physician shall provide Humana or its agents with access to such Equipment for inspection and an opportunity to review all records reflecting Equipment maintenance and service history. Such Equipment shall only be operated by qualified technicians with appropriate training and required licenses and certifications.
9.3 Equipment owned and/or operated by Physician shall comply with all standards for use of such Equipment and technician qualifications established by Humana. Physician agrees to comply with all requests for information related to Equipment and Physician’s and/or Physician’s staff, qualifications for use of same. In the event: (i) Physician’s Equipment fails to meet Humana’s standards; or (ii) Physician declines to comply with Humana’s standards for use of Equipment, Physician agrees that it will not use such Equipment while providing services to Members and shall not bill, charge, seek payment or have any recourse against Humana or Members for any amounts for services with respect to such Equipment.
PROVISION OF MEDICAL SERVICES. Group shall provide Members all available medical services within the normal scope of and in accordance with Group’s licenses, certifications and privileges to provide certain services as delineated by ChoiceCare and/or Payors. Group agrees to comply with all requests for information related to ChoiceCare’s and/or Payors determination of Group’s privileging status. Group shall not ▇▇▇▇, charge, seek payment or have any recourse against ChoiceCare, Payors, or Members for any amounts related to the provision of Group Services for which privileges have not been granted to Group by ChoiceCare.
PROVISION OF MEDICAL SERVICES. UMP Professional agrees to (or to procure its applicable affiliates to) arrange or provide and administer medical services to FTLife Members and/or Family Members, details of which are as follows:
PROVISION OF MEDICAL SERVICES.
A. Provision of Care The PCC shall:
1. Comply with generally accepted medical practice and professional standards in the delivery of medical care to Enrollees;
2. Provide or refer for all Primary Care services covered under the Enrollee’s MassHealth Coverage Type, as specified in 130 CMR 450.105;
3. Inform all MassHealth Standard and CommonHealth Enrollees under age 21 about the EPSDT program, including the benefits of preventative health care, the range of services available under the EPSDT program, including behavioral health services, and where and how to obtain those services;
4. Inform all MassHealth Standard and CommonHealth Enrollees under age 21 that medically necessary services in accordance with 42 U.S.C. § 1396d(a)(4), 42 CFR Part 441 Subpart B, and 130 CMR 450.140 et seq. are available without cost, except as may be provided under federal law, and that necessary transportation and scheduling assistance is available upon request;
5. Offer to screen all MassHealth Enrollees under age 21 in accordance with the EPSDT Periodicity Schedule and 130 CMR 450.140 through 150;
6. Provide or refer all MassHealth Standard and CommonHealth Enrollees under age 21 for all medically necessary treatment services, whether or not included in their coverage type, in accordance with the EPSDT Periodicity Schedule, 130 CMR 450.140 through 149, and applicable prior authorization procedures;
7. Provide or refer all MassHealth Basic, Essential, and Family Assistance Enrollees under age 21 for medically necessary treatment services that are covered by their coverage type, as described in 130 CMR 450.105;
8. Offer to screen using the standardized behavioral health screening tools described in the EPSDT Periodicity Schedule when conducting behavioral health screens according to the EPSDT Periodicity Schedule and 130 CMR 450.140 through 150;
9. Take any other actions with respect to providing and documenting EPSDT screens, referrals, and treatment services that are required by EOHHS, as directed and notified by EOHHS;
10. Inform all Enrollees that family planning services are available to the Enrollee through any MassHealth family planning provider, and that Enrollees do not need a referral in order to receive such services;
11. Not deny any Enrollee MassHealth covered services for which the Enrollee is eligible on account of the Enrollee’s inability to pay the cost sharing; and
12. Acknowledge the rights of Enrollees (see Section 3.6) and take these rights into account w...