Common use of Verification of Eligibility Clause in Contracts

Verification of Eligibility. Crescent will contractually require each TPA or Plan to agree to provide a mechanism for Provider to verify a patient’s eligibility as a Member, based on current information held by Payor or Payor’s designee prior to rendering services. Unless otherwise directed by ▇▇▇▇▇ or TPA, Provider may verify the current status of the Member’s eligibility for Covered Services by requesting the Member to present his or her identification card or by contacting Payor or ▇▇▇▇▇’s designee during normal business hours. So long as Provider substantially complies with such mechanisms, Crescent shall facilitate discussion of mutually agreeable provisions that may be made for cases where incorrect or retroactive information was submitted by employer groups. In addition, Crescent will contractually require Payor not to discontinue coverage for a Member during a confined hospital stay to the extent previously authorized by Payor and consistent with concurrent review procedures. Notwithstanding the foregoing, Provider shall not be required to verify coverage prior to rendering services in an Emergency, and Crescent will use best commercial efforts to require Payors to contractually agree that Provider shall not be denied payment for services rendered in an emergency solely due to Provider’s failure to verify coverage in advance of rendering services. Crescent shall require Payor to contractually agree that Provider shall not be liable to Payor for any refusal or failure to render services to any person for whom coverage cannot be verified in accordance with Payor’s customary administrative procedures.

Verification of Eligibility. Crescent will contractually require each TPA or Plan to agree to provide a mechanism for Provider Facility to verify a patient’s 's eligibility as a Member, based on current information held by Payor or Payor’s designee prior to rendering services. Unless otherwise directed by ▇▇▇▇▇ or TPA, Provider Facility may verify the current status of the Member’s eligibility for Covered Services by requesting the Member to present his or her identification card or by contacting Payor or ▇▇▇▇▇’s designee during normal business hours. So long as Provider Facility substantially complies with such mechanisms, Crescent shall facilitate discussion of mutually agreeable provisions that may be made for cases where incorrect or retroactive information was submitted by employer groups. In addition, Crescent will contractually require Payor not to discontinue coverage for a Member during a confined hospital stay to the extent previously authorized by Payor and consistent with concurrent review procedures. Notwithstanding the foregoing, Provider Facility shall not be required to verify coverage prior to rendering services in an Emergency, and Crescent will use best commercial efforts to require Payors to contractually agree that Provider Facility shall not be denied payment for services rendered in an emergency solely due to ProviderFacility’s failure to verify coverage in advance of rendering services. Crescent shall require Payor to contractually agree that Provider Facility shall not be liable to Payor for any refusal or failure to render services to any person for whom coverage cannot be verified in accordance with Payor’s 's customary administrative procedures.

Verification of Eligibility. Crescent will contractually require each TPA or Plan to agree to provide a mechanism for Provider Physician to verify a patient’s eligibility as a Member, based on current information held by Payor or Payor’s designee prior to rendering services. Unless otherwise directed by ▇▇▇▇▇ or TPA, Provider Physician may verify the current status of the Member’s eligibility for Covered Services by requesting the Member to present his or her identification card or by contacting Payor or ▇▇▇▇▇Payor’s designee during normal business hours. So long as Provider Physician substantially complies with such mechanisms, Crescent shall facilitate discussion of mutually agreeable provisions that may be made for cases where incorrect or retroactive information was submitted by employer groups. In addition, Crescent will contractually require Payor not to discontinue coverage for a Member during a confined hospital stay to the extent previously authorized by Payor and consistent with concurrent review procedures. Notwithstanding the foregoing, Provider Physician shall not be required to verify coverage prior to rendering services in an Emergency, and Crescent will use best commercial efforts to require Payors to contractually agree that Provider Physician shall not be denied payment for services rendered in an emergency solely due to ProviderPhysician’s failure to verify coverage in advance of rendering services. Crescent shall require Payor to contractually agree that Provider Physician shall not be liable to Payor for any refusal or failure to render services to any person for whom coverage cannot be verified in accordance with Payor’s customary administrative procedures.