Common use of Other Settings Clause in Contracts

Other Settings. Services provided by Group Participating Provider in an office or other outpatient setting must be Medically Necessary and appropriate for the diagnosis and treatment of the Member's medical condition. The Plan has designated certain Covered Services which require Prior Authorization in order for the Member to receive the maximum Benefits possible under their Benefit Agreement. Group may request Prior Authorization for services on behalf of the Member. For more information, refer to The Plan's website at ▇▇▇.▇▇▇▇▇▇.▇▇▇.

Other Settings. Services provided by Group Participating Provider in an office or other outpatient setting must be Medically Necessary and appropriate for the diagnosis and treatment of the Member's ’s medical condition. The Plan has designated certain Covered Services which require Prior Authorization in order for the Member to receive the maximum Benefits possible under their Benefit Agreement. Group may request Prior Authorization for services on behalf of the Member. For more information, refer to The Plan's ’s website at ▇▇▇.▇▇▇▇▇▇.▇▇▇.