Within the scope of services definition

Within the scope of services means the set of covered services defined at OAC 317:25-7 and the provisions of the SoonerCare Choice contracts in the SoonerCare Program.
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Within the scope of services means the set of covered services defined at OAC 317:25-7 and the provisions of the SoonerCare Choice contracts in the SoonerCare program(b) Assignment in FFS. Oklahoma's Medicaid State Plan provides that participation in the medical program is limited to providers who accept, as payment in full, the amounts paid by OHCA plus any deductible, coinsurance, or co-payment required by the State Plan to be paid by the member and make no additional charges to the member or others.(1) OHCA presumes acceptance of assignment upon receipt of an assigned claim. This assignment, once made, cannot be rescinded, in whole or in part by one party, without the consent of the other party.(2) Once an assigned claim has been filed, the member must not be billed, and the member is not responsible for any balance except the amount indicated by OHCA. The only amount a member may be responsible for is a co-payment, or the member may be responsible for services not covered under the medical programs. In any event, the member should not be billed for charges on an assigned claim until the claim has been adjudicated or other notice of action received by the provider. Any questions regarding amounts paid should be directed to OHCA, Provider Services.(3) When potential assignment violations are detected, the OHCA will contact the provider to assure that all provisions of the assignment agreement are understood. When there are repeated or uncorrected violations of the assignment agreement, the OHCA is required to suspend further payment to the provider.(c) Assignment in SoonerCare. Any provider who holds a FFS contract and also executes a contract with a provider in the SoonerCare Choice program must adhere to the rules of this subsection regarding assignment.(1) If the service provided to the member is outside of the scope of the services outlined in the SoonerCare contract, then the provider may bill or seek collection from the member.(2) In the event there is a disagreement whether the services are in or out of the scope of the contracts referenced in (1) of this subsection, the OHCA shall be the final authority for this decision.(3) Violation of this provision shall be grounds for a contract termination in the FFS and SoonerCare programs.(d) Cost sharing/co-payment. Section 1902(a)(14) of the Social Security Act permits states to require certain members to share some of the costs of SoonerCare by imposing upon them such payments as enrollment fees, premiums, deductibles, coinsurance...
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Examples of Within the scope of services in a sentence

  • Within the scope of services for which the supervising physician can provide adequate supervision to ensure that accepted standards of medical practice are followed.

  • Within the scope of services used, transporta- tion services constitute a considerable share.

  • Within the scope of services, the Supplier shall draw up collective protocols of service provision in monthly intervals or in other periods as specified in an Order.

  • Within the scope of services permitted by the statutes and regulations governing activities of physician assistants.

  • See Section 3.7. Within the scope of services, the Contractor will recognize Participants’ and inmates’, if applicable, needs for mental health services and other services such as educational and vocational training, social work, case management and religious services, and refer Participants to those services.

  • Unless otherwise agreed in writing, rooms are not available before 2pm on the day of arrival and rooms must be vacated by 11am on the day of departure.

  • Within the scope of services this position has authority to determine the most effective means to achieve approved end results to meet needs within predetermined budgets, standards and processes.

  • Within the scope of services permitted by the statutes and regulations governing activities of nurse practitioners.

  • This process may be expedited if datasets are collected in a consistent way using preferred measurement methods or processes.

  • Within the scope of services identified by the WCB in the attached fee schedule.

Related to Within the scope of services

  • Scope of Services or “Scope of Work” means the work to be performed by the Proposer or Consultant as described in Section 2.0 of this RFP, as amended thereto.

  • Supply of services means any transaction which does not constitute a supply of goods.

  • Restricted Activities means and includes the following:

  • Child in need of services means (i) a child whose behavior, conduct or condition presents or results

  • Educational activity means an activity offered by a school, school district, charter school or county office of education that constitutes an integral fundamental part of elementary and secondary education, including, but not limited to, curricular and extracurricular activities.

  • Sale of services means furnishing or agreeing to furnish services and includes making arrangements to have services furnished by another.

  • Competitive Activities means any business activities in which the Company or any other member of the Company Group engage (or have committed plans to engage) during the Term of Employment, or, following termination of Employee’s employment hereunder, was engaged in business (or had committed plans to engage) at the time of such termination of employment.

  • criminal activity means any kind of criminal involvement in the commission of the following serious crimes:

  • Interscholastic Activities means athletic or non-athletic/academic activities where students compete on a school vs. school basis.

  • COVID-19 Pandemic means the SARS-Cov2 or COVID-19 pandemic, including any future resurgence or evolutions or mutations thereof and/or any related or associated disease outbreaks, epidemics and/or pandemics.

  • Services Commencement Date means the date delivery of the Services shall commence as specified in the Key Provisions. If no date is specified in the Key Provisions this date shall be the Commencement Date;

  • Consultancy Services means the Consultancy Services described in Schedule A;

  • Eligible Services means only those services detailed in the sub-section titled Eligible Services.

  • Investor Relations Activities means any activities, by or on behalf of the Company or a shareholder of the Company, that promote or reasonably could be expected to promote the purchase or sale of securities of the Company, but does not include:

  • School-Sponsored Activity means any activity sponsored, recognized or authorized by the Board and includes activities conducted on or off school property.

  • Cost of Services is FASC’s total Operating Costs incurred in providing the applicable Category of Services during the month to all investment advisers for which FASC provides that Category of Services. “Adviser’s Assets under Management” is the total average assets under management for the month for all Accounts or portions thereof for which the Adviser acts as investment adviser or subadvisor and which utilize the Category of Services.