Common use of REFERRAL SYSTEMS Clause in Contracts

REFERRAL SYSTEMS. A. The contractor shall have a system whereby enrollees needing specialty medical and dental care will be referred timely and appropriately. The system shall address authorization for specific services with specific limits or authorization of treatment and management of a case when medically indicated (e.g., treatment of a terminally ill cancer patient requiring significant specialist care). The contractor shall maintain and submit a flow chart accurately describing the contractor's referral system, including the title of the person(s) responsible for approving referrals. The following items shall be contained within the referral system:

REFERRAL SYSTEMS. A. The contractor shall have a system whereby enrollees needing specialty medical and dental care will be referred timely and appropriately. The system shall address authorization for specific services with specific limits or authorization of treatment and management of a case when medically indicated (e.g., treatment of a terminally ill cancer patient requiring significant specialist care). The contractor shall maintain and submit a flow chart accurately describing the contractor's ’s referral system, including the title of the person(s) responsible for approving referrals. The following items shall be contained within the referral system: