Covered Services Ordered by Medicare Providers for Dual Eligibles Sample Clauses

Covered Services Ordered by Medicare Providers for Dual Eligibles. 2.13.11.1 When a TennCare enrollee is dually eligible for Medicare and TennCare and requires services that are covered under this Agreement but are not covered by Medicare, and the services are ordered by a Medicare provider who is a non-contract provider, the CONTRACTOR must pay for the ordered, medically necessary service if it is provided by a contract provider. 2.13.11.2 Reimbursement shall be at the same rate that would have been paid had the service been ordered by a contract provider. 2.13.11.3 The CONTRACTOR shall not pay for non-covered services, services that are not medically necessary, or services ordered and obtained from non-contract providers.
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Related to Covered Services Ordered by Medicare Providers for Dual Eligibles

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