Services to Members. Provider, within the limitations of Michigan licensure laws, will provide Covered Services to Members based on requirements in Members’ Certificates, BCBSM Medical Necessity criteria as set forth in Addendum A, and as governed by this Agreement and all other BCBSM policies in effect on the dates Covered Services are provided.
Services to Members. 2.1 Subject at all times to the terms of this Agreement, IPA agrees to provide or arrange for medical and related health care services to individuals designated by Humana (herein referred to as “Members”) with an identification card or other means of identifying them as Members covered under a self-funded or fully insured health benefits plan to which IPA has agreed to participate as set forth in the product participation list attachment.
Services to Members. Provider, within the limitations of any applicable state licensure laws, shall provide Covered Services to Members as set forth in Certificates. Provider certifies that all services billed or reported by Provider are within the scope of the rendering healthcare practitioner’s scope of practice or license, if applicable, and are performed personally by the healthcare practitioner, or under his/her direct supervision as defined by BCBSM, or except as otherwise authorized and communicated in writing by BCBSM, and are submitted in accordance with the terms and conditions of the Members' Certificates. Provider will adhere to all BCBSM published guidelines for the provision and billing of Covered Services to Members.
Services to Members. In the event Physician provides a Member a non-covered service or refers a Member to an out-of-network provider without pre-authorization from Humana, Physician shall, prior to the provision of such non-covered service or out-of-network referral, inform the Member: (i) of the service(s) to be provided or referral(s) to be made; (ii) that Humana will not pay or be liable financially for such non-covered service(s) or out-of-network referral(s); and (iii) that Member will be responsible financially for non-covered service(s) and/or out-of-network referral(s) that are requested by the Member.
Services to Members a. The MCO shall have in place an ongoing process of Member education which includes, but is not limited to, development of a Member handbook; provider directory; newsletter; and other Member educational materials. All written materials and correspondence to Members shall be culturally sensitive and written at no higher than a seventh grade reading level. All Member educational materials must be in both English and Spanish.
Services to Members. Each Member hereby acknowledges and recognizes that the Company has retained, and may in the future retain, the services of various professionals, including general and special legal counsel, accountants, architects and engineers, for the purposes of representing and providing services to the Company in the investigation, analysis, acquisition, development, renting, marketing and operation of the Company Assets, or otherwise. Each Member hereby acknowledges that such persons or entities may have in the past represented and performed and currently and/or may in the future represent or perform services for certain of the Members or their Affiliates. Accordingly, each Member and the Company consents to the performance by such persons or entities of services for the Company and waives any right to claim a conflict of interest based on such past or present representation or services to any of the Members or their Affiliates.
Services to Members. Facility, within the limitations of Michigan licensure laws and the limitations of the scope of services Facility provides, will provide Covered Services to Members based on requirements in Members’ Certificates, BCBSM Medical Necessity criteria as set forth in Addendum A, and as governed by this Agreement and all other BCBSM published policies in effect on the dates Covered Services are provided. Facility shall not deny service to any Member solely based upon the level of reimbursement it shall receive for such service.
Services to Members. Facility, within the limitations of its BCBSM approval, and its state licensure laws, will provide Covered Services to Members in exchange for reimbursement from BCBSM pursuant to Section 3.5 of, and as governed by the terms and conditions of this Agreement and all other published BCBSM policies in effect on the dates Covered Services are provided.