Coverage of Emergency Services. is not subject to Prior Authorization requirements, but Contractor may include a requirement in its provider agreements that notice be given to Contractor regarding the use of Out-of-network Providers for Emergency Services. Such notice requirements shall provide at least a forty-eight (48) hour time frame after the Emergency Services for notice to be given to Contractor by the Member and/or the emergency provider. Utilization of and payments to Out-of-network Providers may, at Contractor’s option, be limited to the treatment of Emergency Medical Conditions, including Medically Necessary services rendered to the Member until such time as he or she may be safely transported to a network provider service location. A Member who has an Emergency Medical Condition may not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or to stabilize the patient. The attending emergency physician, or the Provider actually treating the Member, is responsible for determining when the Member is sufficiently stabilized for transfer or discharge, and that determination is binding on the Contractor for coverage and payment.
Appears in 9 contracts
Samples: medicaid.ms.gov, medicaid.ms.gov, medicaid.ms.gov
