Out-of-Network Services. (A) If the Contractor’s network of Network Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Network Provider for the Enrollee for as long as the Contractor is unable to provide them. (B) The Contractor shall require Non-Network Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the network.
Appears in 10 contracts
Sources: Accountable Care Organization (Aco) Contract, Accountable Care Organization (Aco) Contract, Integrated Care Contract
Out-of-Network Services. (A) If the Contractor’s network of Network Participating Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Network Participating Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Network Participating Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the network.
Appears in 10 contracts
Sources: Prepaid Mental Health Plan, Prepaid Mental Health Plan Contract, Prepaid Mental Health Plan Contract
Out-of-Network Services. (A) If the Contractor’s network of Network Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Network Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Network Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the network.
Appears in 7 contracts
Sources: Prepaid Mental Health Plan (Pmhp) Contract, Prepaid Mental Health Plan (Pmhp) Contract, Prepaid Mental Health Plan (Pmhp) Contract
Out-of-Network Services. (A) If the Contractor’s network of Network Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Network Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Network Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the networkby a Network Provider.
Appears in 4 contracts
Sources: Premier Access Contract Prepaid Ambulatory Health Plan (Pahp), McNa Dental Contract, Prepaid Ambulatory Health Plan (Pahp) Contract
Out-of-Network Services. (A) If the Contractor’s network of Network Participating Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Network Participating Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Network Participating Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the networkby a Participating Provider.
Appears in 4 contracts
Sources: Premier Access Chip Contract, Prepaid Ambulatory Health Plan (Pahp) Contract, Chip Premier Access Dental Contract Amendment 2
Out-of-Network Services. (A) If the Contractor’s network of Network Participating Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Network Participating Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require use reasonable efforts to ensure that (i) Non-Network Participating Providers to coordinate with the Contractor with respect to payment and ensure that (ii) the cost to the Enrollee is no greater than it would be if the services were furnished within the networkby a Participating Provider.
Appears in 2 contracts
Sources: Chip Dentaquest Amendment 2, Contract
Out-of-Network Services. (A) If the Contractor’s network of Network Participating Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular an Enrollee, the Contractor shall adequately and timely cover these services using a Non-Network Participating Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Network Participating Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the cost of the services were furnished within the network.
Appears in 1 contract
Sources: Contract