CalOptima Direct definition
Examples of CalOptima Direct in a sentence
CalOptima recognizes that CalOptima Direct or CalOptima Health Network members have the right to choose to seek their family planning services outside of the Health Network/CalOptima.
Eligibility/ Client Services County/Family Planning will provide family planning services to FamilyPACT eligible CalOptima Direct or CalOptima Health Network members choosing to seek such services outside of their Health Network or CalOptima.
Orangewood residents who become Medi-Cal eligible with a CalOptima aid code as a result of their placement shall initially be enrolled in CalOptima Direct.
CalOptima Direct or the member’s Health Network shall reimburse CHOC Emergency Department and any related provider services for an MSE without prior authorization, regardless of the outcome of the MSE.
CalOptima Direct or the member’s Health Network shall reimburse all services medically necessary to diagnose and stabilize the patient, without prior authorization.
Children may remain in CalOptima Direct or, at the discretion of the caregiver; CalOptima shall assist with transition of the minor into the Health Network of the caregiver’s choice.
CalOptima will pay County for covered non-PPS medical services provided to CalOptima Direct Members.
For CalOptima Direct Members, PDS Hospital Liaison will contact CalOptima case management.
Reimbursement shall be available for authorized Medical Respite Care for CalOptima Members following the 90-day Whole-Person Care Recuperative Care stay, whether the Member is assigned to CalOptima Direct, to a CalOptima Shared Risk Health Network, to a CalOptima HMO Health Network, or to a CalOptima Physician-Hospital Consortium.
Sick care (i.e. non-CHDP/PPS services) will be provided to CalOptima Direct patients only.