COUNTY Director of Children and Family Services shall have the. 24 final right and sole discretion to resolve any dispute as to the necessity and 25 appropriateness of services and length of services.
COUNTY Director of Children and Family Services shall have the Sample Clauses
Related to COUNTY Director of Children and Family Services shall have the
Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.
COVERED HEALTHCARE SERVICES This section describes covered healthcare services. This plan covers services only if they meet all of the following requirements: • Listed as a covered healthcare service in this section. The fact that a provider has prescribed or recommended a service, or that it is the only available treatment for an illness or injury does not mean it is a covered healthcare service under this plan. • Medically necessary, consistent with our medical policies and related guidelines at the time the services are provided. • Not listed in Exclusions Section. • Received while a member is enrolled in the plan. • Consistent with applicable state or federal law. We review medical necessity in accordance with our medical policies and related guidelines. Our medical policies can be found on our website. Our medical policies are written to help administer benefits for the purpose of claims payment. They are made available to you for informational purposes and are subject to change. Medical policies are not meant to be used as a guide for your medical treatment. Your medical treatment remains a decision made by you with your physician. If you have questions about our medical policies, please call Customer Service. When a new service or drug becomes available, when possible, we will review it within six (6) months of one of the events described below to determine whether the new service or drug will be covered: • the assignment of an American Medical Association (AMA) Current Procedural Terminology (CPT) code in the annual CPT publication; • final Food and Drug Administration (FDA) approval; • the assignment of processing codes other than CPT codes or approval by governing or regulatory bodies other than the FDA; • submission to us of a claim meeting the criteria above; and • generally, the first date an FDA approved prescription drug is available in pharmacies (for prescription drug coverage only). During the review period, new services and drugs are not covered. For all covered healthcare services, please see the Summary of Medical Benefits and the Summary of Pharmacy Benefits to determine the amount that you pay and any benefit limits.
Covered Health Care Services We agree to provide coverage for medically necessary covered health care services listed in this agreement. If a service or category of service is not specifically listed as covered, it is not covered under this agreement. Only services that we have reviewed and determined are eligible for coverage under this agreement are covered. All other services are not covered. See Section 1.4 for how we identify new services and our guidelines for reviewing and making coverage determinations. We only cover a service listed in this agreement if it is medically necessary. We review medical necessity in accordance with our medical policies and related guidelines. The term medically necessary is defined in Section 8.0 - Glossary. It does not include all medically appropriate services. The amount of coverage we provide for each health care service differs according to whether or not the service is received: • as an inpatient; • as an outpatient; • in your home; • in a doctor’s office; or • from a pharmacy. Also coverage differs depending on whether: • the health care provider is a network provider or non-network provider; • deductibles (if any), copayments, or maximum benefit apply; • you have reached your plan year maximum out-of-pocket expense; • there are any exclusions from coverage that apply; or • our allowance for a covered health care service is less than the amount of your copayment and deductible (if any). In this case, you will be responsible to pay up to our allowance when services are rendered by a network provider. Please see the Summary of Medical Benefits to determine the benefit limits and amount that you pay for the covered health care services listed below. Please see the Summary of Pharmacy Benefits to determine the benefit limits and amount that you pay for prescription drug and diabetic equipment and supplies purchased at a pharmacy.
Routing for Operator Services and Directory Assistance Traffic For a Verizon Telecommunications Service dial tone line purchased by MLTC for resale pursuant to the Resale Attachment, upon request by MLTC, Verizon will establish an arrangement that will permit MLTC to route the MLTC Customer’s calls for operator and directory assistance services to a provider of operator and directory assistance services selected by MLTC. Verizon will provide this routing arrangement in accordance with, but only to the extent required by, Applicable Law. Verizon will provide this routing arrangement pursuant to an appropriate written request submitted by MLTC and a mutually agreed-upon schedule. This routing arrangement will be implemented at MLTC's expense, with charges determined on an individual case basis. In addition to charges for initially establishing the routing arrangement, MLTC will be responsible for ongoing monthly and/or usage charges for the routing arrangement. MLTC shall arrange, at its own expense, the trunking and other facilities required to transport traffic to MLTC’s selected provider of operator and directory assistance services.
Clinical Management for Behavioral Health Services (CMBHS) System The CMBHS is the official record of documentation by System Agency. Grantee shall:
State of New York Executive Department Office of General Services Procurement Services Corning Tower - 00xx Xxxxx Xxxxxx Xxxxx Xxxxx Xxxxxx, XX 00000 THIS CONTRACT (hereinafter “Contract” or “Centralized Contract”) for the acquisition of Project Based Information Technology Consulting Services is made between the People of the State of New York, acting by and through the Commissioner of the Office of General Services (hereinafter “State” or “OGS”) whose principal place of business is the 41st Floor, Corning Tower, The Governor Xxxxxx X. Xxxxxxxxxxx Empire Xxxxx Xxxxx, Xxxxxx, Xxx Xxxx 00000, pursuant to authority granted under New York State Finance Law §163, and SVAM INTERNATIONAL, INC. (hereinafter “Contractor”), with its principal place of business at 000 Xxxx Xxxxx Xxxx, Xxxxx 000, Xxxxx Xxxx, XX 00000. The foregoing are collectively referred to as the “Parties.”
GENERAL ADMINISTRATION AND MANAGEMENT The City Manager of the City, or designee, shall be the City’s representative, and shall oversee and approve all services to be performed, coordinate all communications, and review and approve all invoices, under this Agreement.
AIN Selective Carrier Routing for Operator Services, Directory Assistance and Repair Centers 4.3.1 BellSouth will provide AIN Selective Carrier Routing at the request of <<customer_name>>. AIN Selective Carrier Routing will provide <<customer_name>> with the capability of routing operator calls, 0+ and 0- and 0+ NPA (LNPA) 555-1212 directory assistance, 1+411 directory assistance and 611 repair center calls to pre-selected destinations.
Habilitative Services Habilitative Services are healthcare services that help you keep, learn, or improve skills and functioning for daily living. These services are Covered and may require Prior Authorization. Examples include therapy for a child who isn’t walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings.
Outpatient Services The following services are covered only at the Primary Care Provider’s office[selected by a [Member], or elsewhere [upon prior written Referral by a [Member]'s Primary Care Provider ]:
