Covering Physicians. Physicians agrees to provide or arrange to provide coverage for all Members under the Physician's care twenty-four (24) hours per day, each day of the year. If Physician is, for any reason, from time to time unable to provide Covered Services when and as needed, Physician may secure the services of a qualified physician (the "Covering Physician") who shall render such Covered Services otherwise required of Physician. Covering Physician must be approved by IPA to provide Covered Services to Members and Physician shall notify IPA in advance of Covering Physician providing any services hereunder by giving his or her name, qualifications, address and telephone number and such other pertinent information as shall be required by IPA. Physician shall be solely responsible for securing services of such Covering Physician. It will be Physician's responsibility to ensure that the Covering Physician (i) will not seek reimbursement from the Plan for Covered Services under the terms of this Agreement unless the payment arrangement with the Plan permits the Covering Physician to be paid directly by the Plan for such services, (ii) will abide by IPA's and Plan's policies and procedures including Utilization Management and Quality Management, and (iii) agrees to be bound by all other provisions of this Agreement relating to the delivery of Covered Services. Physician agrees to accept responsibility for costs associated with any deviations of Covering Physician from above requirements.
Covering Physicians. PCP shall make necessary and appropriate arrangements with Covering Physicians to ensure the availability of Primary Care Services to Members twenty-four (24) hours per day, seven (7) days per week, including arrangements to ensure coverage of Members after hours or when PCP is otherwise unavailable. PCP shall ensure that Covering Physicians are Participating Providers, except as otherwise consented to by VISTA in writing. PCP shall ensure that Covering Physicians adhere to the terms of this Agreement and all VISTA Policies and that Covering Physicians seek required Pre-Authorization from VISTA, or Refer the Member back to PCP, as required by VISTA Policies, except for Emergency Services or Urgently Needed Services or as otherwise permitted under the applicable VISTA Coverage Plan. Except for Hospitalist Physicians (as defined below), with respect to Capitated Services (as defined below), PCP shall be solely liable to Covering Physicians for the amount and manner in which Covering Physicians are reimbursed or otherwise compensated for services rendered to Members on PCP’s behalf. PCP acknowledges and agrees that VISTA shall not have any financial obligation whatsoever to Covering Physicians with respect to Capitated Services. PCP shall ensure that Covering Physicians do not, under any circumstances, bxxx Members for Covered Services other than for applicable Co-Payments, Deductibles and Co-Insurance. PCP hereby agrees to indemnify and hold harmless Members, AHCA, DOI, and CMS against charges for Covered Services rendered by Covering Physicians. All charges incurred for services rendered pursuant to a Pre-Authorization or Referral made by a Covering Physician, other than a Referral back to PCP, shall, unless such Pre-Authorization or Referral was approved by VISTA in advance and in writing or as otherwise permitted under the applicable VISTA Coverage Plan, be borne by PCP who shall be liable for all costs, fees, charges and expenses associated with such services.
Covering Physicians. The Group shall require that Group Physicians provide or arrange to provide coverage for all Members under Group Physicians' care twenty-four (24) hours per day, each day of the year. If a Group Physician is, for any reason, from time to time, unable to provide Covered Services when and as needed, the Group Physician may secure the services of a qualified physician (the "Covering Physician") who shall render such Covered Services otherwise required of the Group Physician. Covering Physician must be approved in writing by IPA to provide Covered Services to Members and the Group shall cause Group Physicians to notify IPA in advance of Covering Physician providing any services hereunder by giving Covering Physician's name, qualifications, address and telephone number and such other pertinent information as shall be required by IPA. The Group agrees that its Group Physicians shall be solely responsible for securing services of such Covering Physician. It will be the Group Physician's responsibility to ensure that the Covering Physician (i) will not seek reimbursement from the Plan for Covered Services under the terms of this Agreement unless the payment arrangement with the Plan permits the Covering Physician to be paid directly by the Plan for such services, (ii) will abide by IPA's and Plan's policies and procedures including Utilization Management and Quality Management, and (iii) agrees to be bound by all other provisions of this Agreement relating to the delivery of Covered Services. The Group agrees to accept responsibility for costs associated with any deviations of Covering Physician from above requirements.
