ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES Clause Samples
The 'Additional Provider Requirements for Specific Activities' clause sets out extra obligations or standards that a service provider must meet when performing certain designated tasks or services. These requirements may include specialized training, certifications, compliance with particular laws, or the use of specific equipment for activities such as handling hazardous materials or working with vulnerable populations. By detailing these tailored requirements, the clause ensures that providers are properly qualified and prepared for specialized activities, thereby reducing risk and ensuring compliance with relevant regulations.
ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES. 4.1 Primary Care Provider (PCP) Responsibilities. The PCP must serve as the Covered Person’s initial and most important point of interaction within Subcontractor or Health Plan network. As such, PCP responsibilities must include at a minimum:
(a) Serving as the Covered Person’s Primary Care Provider;
(b) Making referrals for specialty care and other Medically Necessary services, both in- and out-of-plan;
(c) Maintaining a current medical record for the Covered Person; and
(d) Referring Covered Persons for care management services.
ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES. 4.1. Primary Care Provider (PCP) Responsibilities. The PCP must serve as the Covered Person’s initial and most important point of interaction within the Subcontractor or Health Plan network. As such, PCP responsibilities include the following, as further described in the provider manual:
(a) Serving as the Covered Person’s Primary Care Provider;
(b) Making referrals for specialty care and other Medically Necessary services, both in- and out-of-plan;
(c) Coordinating and implementing an individualized care plan for the Covered Person; and
(d) Delivering team-based integrated primary and behavioral health Covered Services to Covered Persons and coordinate care with other providers, including the assembly of an interdisciplinary care team, as appropriate.
ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES. Nursing Facilities and Hospice. Bed hold days shall be consistent with Medicaid fee- for-service bed hold day’s policies and procedures.
ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES. 4.1 Pharmacy Providers. Payment for pharmacy providers shall be consistent with NMSA 1978, § 27-2-16B unless there is a change in statute or regulation;
ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES. Pre-natal/Obstetric Care.
ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES. 4.1 In the event of a change of ownership, the Provider shall register with the Division of TennCare to obtain a new Medicaid Identification Number.
4.2 Provider shall accept payment or appropriate denial made by Subcontractor or Health Plan, as applicable, (or, if applicable, payment by Subcontractor or Health Plan that is supplementary to the Covered Person’s third party payer) plus the amount of any applicable Patient Liability, as payment in full for services provided and shall not solicit or accept any surety or guarantee of payment from a Covered Person in excess of the amount of applicable Patient Liability. For purposes of this Section 4.6(e), Covered Person shall include the patient, parent(s), guardian, spouse or any other legally responsible person of the Covered Person being served.
ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES. Mental Health and Substance Use Providers. Providers who provide Mental Health and Substance Use services to Covered Persons must provide for services to be delivered in
ADDITIONAL PROVIDER REQUIREMENTS FOR SPECIFIC ACTIVITIES