NMAC Current patients are covered persons who have a claim with Presbyterian Health Plan (PHP) related to the provider's services within the past year, or who have received a pre-authorization prior to termination to use the provider's services at a future time. PHP will assist such affected covered persons in locating and transferring to another similarly qualified provider. A covered person may not be held financially liable for services received from the provider in good faith between the effective date of the suspension or termination and the receipt of notice provided to the covered person, if the covered person has not received comparable notice during this time from the provider. Out-of-network (outside of the 5-county area) Practitioners/Providers are healthcare Practitioners/Providers, including non-medical facilities, who have not entered into an agreement with us to provide Healthcare Services to PHP Members on this plan. Covered Healthcare Services obtained from an Out-of-network (outside of the 5-county area) Practitioner/Provider or outside the Service Area will not be Covered unless such services are not reasonably available from an In-network Practitioner/Provider or in cases of urgent or an emergency. You will not pay higher or additional Cost Sharing amounts under such circumstances. These provisions also apply to Telehealth services. If you pay a non-participating Provider more than the in-network cost-sharing amount for services provided under circumstances giving rise to a surprise bill, the non-participating Provider must refund to you within 45 days of receipt of payment from Presbyterian any amount paid in excess of the in-network cost-sharing amount. In accordance with the hearing procedures established pursuant to the Patient Protection Act [Chapter 59, Article 57 NMSA 1978], you may appeal Presbyterian’s determination made regarding a surprise bill. Services provided by an Out-of-network (outside of the 5-county area) Practitioner/Provider, except for urgent or Emergency services, require that your Primary Care Physician request and obtain written approval (Authorization) from our Medical Director BEFORE services are rendered. Otherwise, you may be responsible for payment. Please refer to the Prior Authorization Section for more information on Prior Authorization requirements. If the services of an Out-of-network (outside of the 5-county area) Practitioner/Provider are required, your In-network Practitioner/Provider must request and obtain Prior Authorization from our Medical Director BEFORE services are performed, otherwise, we may not Cover the services and you may be responsible for payment. Before the Medical Director may deny a request for specialist services that are unavailable from an In-Network Practitioner/Provider, the request must be reviewed by a specialist similar to the type of specialist to whom the Prior Authorization is requested. In determining whether a Prior Authorization to an Out-of-network (outside of the 5-county area) Practitioner/Provider is reasonable, we will consider the following circumstances: Availability – The In-network Practitioner/Provider is not reasonably available to see you in a timely fashion as dictated by the clinical situation.
Servicer ARM_INDEX_RATE The index the Servicer is using to calculate 4 Max length of 6 6 a forecasted rate. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- ACTL_BEG_PRIN_BAL The borrower's actual principal balance at 2 No commas(,) or dollar signs ($) 11 the beginning of the processing cycle. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- ACTL_END_PRIN_BAL The borrower's actual principal balance at 2 No commas(,) or dollar signs ($) 11 the end of the processing cycle. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- BORR_NEXT_PAY_DUE_DATE The date at the end of processing cycle that MM/DD/YYYY 10 the borrower's next payment is due to the Servicer, as reported by Servicer. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SERV_CURT_AMT_1 The first curtailment amount to be applied. 2 No commas(,) or dollar signs ($) 11 -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SERV_CURT_DATE_1 The curtailment date associated with the MM/DD/YYYY 10 first curtailment amount. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- CURT_ADJ_ AMT_1 The curtailment interest on the first 2 No commas(,) or dollar signs ($) 11 curtailment amount, if applicable. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SERV_CURT_AMT_2 The second curtailment amount to be applied. 2 No commas(,) or dollar signs ($) 11 -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SERV_CURT_DATE_2 The curtailment date associated with the MM/DD/YYYY 10 second curtailment amount. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- CURT_ADJ_ AMT_2 The curtailment interest on the second 2 No commas(,) or dollar signs ($) 11 curtailment amount, if applicable. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SERV_CURT_AMT_3 The third curtailment amount to be applied. 2 No commas(,) or dollar signs ($) 11 -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SERV_CURT_DATE_3 The curtailment date associated with the MM/DD/YYYY 10 third curtailment amount. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- CURT_ADJ_AMT_3 The curtailment interest on the third 2 No commas(,) or dollar signs ($) 11 curtailment amount, if applicable. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- PIF_AMT The loan "paid in full" amount as reported 2 No commas(,) or dollar signs ($) 11 by the Servicer. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- PIF_DATE The paid in full date as reported by the MM/DD/YYYY 10 Servicer. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- ACTION_CODE The standard FNMA numeric code used to Action Code Key: 15=Bankruptcy, 2 indicate the default/delinquent status of a 30=Foreclosure, , 60=PIF, particular loan. 63=Substitution, 65=Repurchase,70=REO -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- INT_ADJ_AMT The amount of the interest adjustment as 2 No commas(,) or dollar signs ($) 11 reported by the Servicer. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SOLDIER_SAILOR_ADJ_AMT The Soldier and Sailor Adjustment amount, if 2 No commas(,) or dollar signs ($) 11 applicable. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- NON_ADV_LOAN_AMT The Non Recoverable Loan Amount, if 2 No commas(,) or dollar signs ($) 11 applicable. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- LOAN_LOSS_AMT The amount the Servicer is passing as a 2 No commas(,) or dollar signs ($) 11 loss, if applicable. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SCHED_BEG_PRIN_BAL The scheduled outstanding principal amount 2 No commas(,) or dollar signs ($) 11 due at the beginning of the cycle date to be passed through to investors. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SCHED_END_PRIN_BAL The scheduled principal balance due to 2 No commas(,) or dollar signs ($) 11 investors at the end of a processing cycle. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SCHED_PRIN_AMT The scheduled principal amount as reported 2 No commas(,) or dollar signs ($) 11 by the Servicer for the current cycle -- only applicable for Scheduled/Scheduled Loans. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- SCHED_NET_INT The scheduled gross interest amount less the 2 No commas(,) or dollar signs ($) 11 service fee amount for the current cycle as reported by the Servicer -- only applicable for Scheduled/Scheduled Loans. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- ACTL_PRIN_AMT The actual principal amount collected by the 2 No commas(,) or dollar signs ($) 11 Servicer for the current reporting cycle -- only applicable for Actual/Actual Loans. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- ACTL_NET_INT The actual gross interest amount less the 2 No commas(,) or dollar signs ($) 11 service fee amount for the current reporting cycle as reported by the Servicer -- only applicable for Actual/Actual Loans. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- PREPAY_PENALTY_ AMT The penalty amount received when a borrower 2 No commas(,) or dollar signs ($) 11 prepays on his loan as reported by the Servicer. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- PREPAY_PENALTY_ WAIVED The prepayment penalty amount for the loan 2 No commas(,) or dollar signs ($) 11 waived by the servicer. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- MOD_DATE The Effective Payment Date of the MM/DD/YYYY 10 Modification for the loan. -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- MOD_TYPE The Modification Type. Varchar - value can be alpha or 30 numeric -------------------------- ---------------------------------------------- --------- ------------------------------------ --------- DELINQ_P&I_ADVANCE_AMT The current outstanding principal and 2 No commas(,) or dollar signs ($) 11 interest advances made by Servicer. -------------------------- ---------------------------------------------- --------- ------------------------------------ ---------