Plan Network definition
Examples of Plan Network in a sentence
You agree that when the need arises for a State Health Plan Member to receive other professional services, hospital, or other institutional services, or supplies, outside of the scope of services that you provide, you will assist with the referral, admission and/or transfer of the State Health Plan Member locally within the North Carolina State Health Plan Network, when reasonably possible and consistent with good medical care.
You are required to provide us with the information required to make payment by EFT as a condition of participation in the North Carolina State Health Plan Network.
In the event you become contracted into the North Carolina State Health Plan Network through a third party after the effective date of this Agreement, this Agreement will automatically enter a state of dormancy for the applicable Benefit Plan(s).
You agree to maintain medical records on the same basis as for all other patients, and to make such information available to us and other North Carolina State Health Plan Network providers when necessary for the treatment and evaluation of State Health Plan Members or as otherwise required by our Policies and Procedures or determined by us, as permitted by law or the terms and conditions governing the State Health Plan Member’s Benefit Plan.
You agree not to use the name of the State of North Carolina, Department of State Treasurer, the State Health Plan, or the North Carolina State Health Plan Network as part of any commercial advertising or marketing products or services.
Each Enrolled Employee shall select a Plan Medical Group (“PMG”) and a Primary Care Physician from the selected Plan Network on behalf of himself or herself and each of his or her Dependents at the time of enrollment in Plan.
A list of the names and locations of Plan Providers in the selected Plan Network is contained in the Provider Directory, which may be obtained by calling Plan at ▇▇▇-▇▇▇-▇▇▇▇ or ▇-▇▇▇-▇▇▇-▇▇▇▇.
The Enrolled Employee may select a different PMG and/or Primary Care Physician from the selected Plan Network for himself or herself and for each of his or her Dependents.
You agree to notify us of any case that would result in medical care being provided or denied to a State Health Plan Member that you believe to be inappropriate and contrary to accepted professional or ethical standards of medical practice as a result of our administrative or utilization management processes, the availability of the North Carolina State Health Plan Network, or our benefit determinations.
You further agree that you will not limit, restrict, or prohibit a Practitioner by contract or otherwise from exercising their independent medical judgment and referring State Health Plan Members to any participating provider in the North Carolina State Health Plan Network that the Practitioner chooses and deems to be in the best interest of the Plan Member when balancing quality, affordability, and the medical needs of the State Health Plan Member.