Common use of Care Conference Coverage Clause in Contracts

Care Conference Coverage. As described in further detail in Section 5.3.2, the Contractor shall engage the member’s provider in care management through semi-annual care conferences. The Contractor shall reimburse the provider for participation in these care conferences. Services must be billed using Healthcare Common Procedure Coding System (HCPCS) 99211 SC – “office or other outpatient visit for the evaluation and management of an established patient.” Contractors who elect not to utilize a primary medical provider (PMP) model, as described in Section 6.2.3, shall propose to FSSA for review and approval their proposed process for identifying what provider(s) will be engaged in the care conference process and what provider(s) will be eligible for reimbursement for the care conference.