Hospital Admissions. In recognition of the need for coordination, continuity, and quality of care of Covered Services provided to Medical Group Members, Medical Group agrees to utilize Hospital(s) as provider of Hospital Services for Medical Group Members, subject to the following exceptions:
Hospital Admissions. Whenever IPA determines that a Subscriber on IPA's eligibility list requires Hospital Services which are not Emergency Services, IPA shall arrange for such Hospital admissions and outpatient surgeries through the IPA's Utilization Review Committee and its developed utilization review program. IPA and its Member Physicians shall not serve as admitting physicians for any Subscriber without such prior approval except in the event that Emergency Services are required. If IPA or a Member Physician admits a Subscriber to a Hospital for Emergency Services, IPA shall notify PacifiCare of such admission within the time frames as required in the PacifiCare Provider Policies and Procedures Manual, attached hereto as Attachment D and incorporated in full herein by reference. Admissions for Emergency Services or Urgently Needed Services shall be made to hospitals contracting with PacifiCare, if possible.
Hospital Admissions. If you are admitted to a non-Plan Hospital, you, your Parent/Guardian, Financially Responsible Person or someone else must notify us within the later of forty-eight (48) hours of a Member’s hospital admission or on the first working day following the admission unless it was not reasonably possible to notify us within that time.
Hospital Admissions. In cases where a Covered Person requires a non-emergency hospital admission by Physician, Physician agrees to secure authorization for such admission from the Medical Director, or his/her designee, prior to the admission if such prior authorization is required under the applicable Plan. Physician understands that any extension of the initial covered length of stay may require prior authorization from the Medical Director, or his/her designee, under the applicable Plan. Physician shall abide by any utilization review protocols established for the applicable Plan with respect to hospital admissions; provided, however, Physician and VIVA Health agree that all clinical decisions shall ultimately be decided by Physician.
Hospital Admissions. FARA shall, unless otherwise set forth in this agreement or an attachment hereto, require that Qualified Participants of RCN requiring admission to a Participating Hospital be considered for admission in accordance with the policies and procedures of Participating Hospitals. 3.5
Hospital Admissions. If you are admitted to a non-Plan Hospital, you, your Parent/Guardian, Financially Responsible Person or someone else must notify us within the later of forty-eight (48) hours of a Member’s hospital admission or on the first working day following the admission unless it was not reasonably possible to notify us within that time. Getting Assistance from Our Advice Nurses Our advice nurses are registered nurses (RNs) specially trained to help assess clinical problems and provide clinical advice. They can help solve a problem over the phone and instruct you on self-care at home, when appropriate. If the problem is more severe and you need an appointment, they will help you get one. If you are not sure you are experiencing a medical emergency, or for Urgent Care Services for symptoms such as a sudden rash, high fever, severe vomiting, ear infection or sprain, you may call our advice nurses at 0-000-000-0000 or 711 (TTY). You may also call 0-000-000-0000 from anywhere in the United States, Canada, Puerto Rico or the Virgin Islands. Getting a Second Opinion You are welcome to receive a second medical opinion from a Plan Physician. We will assist you to arrange an appointment for a second opinion upon request. Moving to Another Xxxxxx Permanente or Group Health Cooperative Service Area If you move to another Xxxxxx Permanente or Group Health Cooperative service area, you may be able to transfer your Group membership if there is an arrangement with your Group in the new service area. However, eligibility requirements, benefits, Premium, Copayments, Coinsurance and Deductibles may not be the same in the other service area. You should contact your Group’s employee benefits coordinator before you move. Receiving Care in Another Xxxxxx Foundation Health Plan Service Area You may receive covered Services from another Xxxxxx Foundation Health Plan, if the Services are provided, prescribed, or directed by that other plan, and if the Services would have been covered under this EOC. Covered Services are subject to the terms and conditions of this EOC, including prior authorization requirements, the applicable Copayments, Coinsurance and/or Deductibles shown in the Summary of Services and Cost Shares and the exclusions, limitations and reductions described in this EOC. For more information about receiving care in other Xxxxxx Foundation Health Plan service areas, including availability of Services, and provider and facility locations, please call our Away from Home Travel Li...
Hospital Admissions. If you are admitted to a non-Plan Hospital, you, your Parent/Guardian, Financially Responsible Person or someone else must notify us within the later of forty-eight (48) hours of a Member’s hospital admission or on the first working day following the admission unless it was not reasonably possible to notify us within that time. Getting Assistance from Our Advice Nurses Our advice nurses are registered nurses (RNs) specially trained to help assess clinical problems and provide clinical advice. They can help solve a problem over the phone and instruct you on self-care at home, when appropriate. If the problem is more severe and you need an appointment, they will help you get one. If you are not sure you are experiencing a medical emergency, or for Urgent Care Services for symptoms such as a sudden rash, high fever, severe vomiting, ear infection or sprain, you may call our advice nurses at 0-000-000-0000 or 711 (TTY). You may also call 0-000-000-0000 from anywhere in the United States, Canada, Puerto Rico or the Virgin Islands.
Hospital Admissions. 19.1.2 PROVIDER shall comply, in a timely and accurate manner, with the requirements for electronic submission of claims, referrals, and preauthorization’s as well as any other electronic submission initiative established by ASES, First Medical and/or IMC.
Hospital Admissions. Network shall require Network Providers to admit to, and provide appropriate services at a Participating Hospital to Members in the event a hospital group does not exist. Network shall require Network Providers to maintain clinical privileges at a Participating Hospital. If a Network Provider does not have admitting privileges at a Participating Hospital such Network Provider may identify another Participating Provider as the Admitting Physician who shall take responsibility for admission and provision of inpatient services to Members twenty four (24) hours per day/three hundred sixty five (365) days per year. Such Network Provider shall be responsible for the remuneration of the Admitting Physician which Admitting Physician shall sign an Acceptance Letter in the form attached as Attachment D. Admission to a Participating Hospital must be certified in advance by Plan in accordance with Plan's Utilization Management Program.
Hospital Admissions. MSO and/or Plan shall cause MSO Providers or Plan’s Admitting Physician panel to admit to, and provide appropriate services at, a Participating Hospital to Members. MSO and/or Plan shall cause MSO Providers or Plan’s Admitting Physician Panel to maintain clinical privileges at a Participating Hospital. Non-emergency admission to a Participating Hospital must be certified in advance by Plan or MSO in accordance with the approved Utilization Management Program.
