CalOptima Direct definition

CalOptima Direct. (COD) means a program CalOptima administers for CalOptima Members not enrolled in a Health Network. COD consists of two components:
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Examples of CalOptima Direct in a sentence

  • County and CalOptima Responsibilities CATEGORY County Family Planning Clinic CalOptima/Health Networks 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.

  • For CalOptima Direct Members, PDS Hospital Liaison will contact CalOptima case management.

  • CalOptima Direct or the member’s Health Network shall reimburse all services medically necessary to diagnose and stabilize the patient, without prior authorization.

  • 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.

  • 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.

  • 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.

  • 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.

  • Notification County/JHS - Orangewood staff shall notify the Health Network or CalOptima Direct as soon as practical when a resident has received Notification information that is received shall be reviewed for coordination of care and case Category County/JHS – Orangewood SSA/OCFC CalOptima/Health Networks non-emergent off-site services.

  • 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.

Related to CalOptima Direct

  • Objective medical evidence means reports of examinations or treatments; medical

  • Drug therapy management means the review of a drug therapy regimen of a patient by one or more pharmacists for the purpose of evaluating and rendering advice to one or more practitioners regarding adjustment of the regimen.

  • Designated mental health professional means a mental health

  • School nurse means a registered professional nurse with Maine Department of Education certification for school nursing.

  • Licensed mental health professional or "LMHP" means a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, licensed behavior analyst, or licensed psychiatric/mental health nurse practitioner.

  • Integrated pest management means careful consideration of all available plant protection methods and subsequent integration of appropriate measures that discourage the development of populations of harmful organisms and keep the use of plant protection products and other forms of intervention to levels that are economically and ecologically justified and reduce or minimise risks to human health and the environment. ‘Integrated pest management’ emphasises the growth of a healthy crop with the least possible disruption to agro-ecosystems and encourages natural pest control mechanisms;

  • DEVELOPMENTAL SERVICES means therapies, typically provided by a qualified professional using a treatment plan, that are intended to lessen deficiencies in normal age appropriate function. The therapies generally are meant to limit deficiencies related to injury or disease that have been present since birth. This is true even if the deficiency was detected during a later developmental stage. The deficiency may be the result of injury or disease during the developmental period. Developmental services are applied for sustained periods of time to promote acceleration in developmentally related functional capacity. This plan covers developmental services unless specifically listed as not covered.

  • Supply Chain Management All aspects of supply chain management, from the initial sourcing phase through customer delivery (e.g., procurement, sourcing management, inventory management, catalog management, ordering/purchasing, invoice tracking, storefront/shopping cart, warehouse management, returns management, logistics/transportation).

  • Step therapy means a protocol or

  • Technical Committee means the body established in accordance with article VII;

  • Biometrics means a technique of personal identification that is based on physical, physiological or behavioural characterisation including blood typing, fingerprinting, DNA analysis, retinal scanning and voice recognition;

  • Asset Management Company/UTI AMC/AMC/Investment Manager means the UTI Asset Management Company Limited incorporated under the Companies Act, 1956, (1 of 1956) [replaced by The Companies Act, 2013 (No.18 of 2013)] and approved as such by Securities and Exchange Board of India (SEBI) under sub-regulation (2) of Regulation 21 to act as the Investment Manager to the schemes of UTI Mutual Fund.

  • Non-Management Director means any Person selected in accordance with Article IV of this Agreement who is not a Management Director.