Crisis, Urgent and Emergency Services Sample Clauses

Crisis, Urgent and Emergency Services. (1) Contractor may not require Prior Authorization for Emergency Services nor limit what constitutes an Emergency Medical Condition on the basis of lists of diagnoses or symptoms. (2) Contractor shall provide an after-hours call-in system adequate to triage Urgent Care and Emergency Service calls, consistent with OAR 410-141-3840. (3) As provided for in OAR 410-141-3840 and 42 CFR § 438.114, Contractor shall not deny and is required to pay for a claim for Emergency Services, regardless of whether the Provider that furnishes the services has a contract with Contractor. (4) Contractor is encouraged to establish agreements with Hospitals in its Service Area for the payment of emergency screening exams. (5) Contractor shall not deny payment for treatment obtained when a Member has an Emergency Medical Condition, including Behavioral Health, or requires Dental Emergency Services, including cases in which the absence of immediate medical attention would not have had the outcomes specified in the definition of Emergency Medical Condition. (6) Contractor shall cover and pay for Post Stabilization Services, as provided for in OAR 410-141-3840 and 42 CFR § 438.114. Contractor is financially responsible for (7) Contractor’s financial responsibility for Post Stabilization Services it has not pre- approved ends when the Member is discharged, consistent with the requirements of 42 CFR § 438.114. (8) Contractor shall cover Post Stabilization Services administered to maintain, improve, or resolve the Member’s stabilized condition without preauthorization, and regardless of whether the Member obtains the services within Contractor’s network, when Contractor could not be contacted for pre-approval or did not respond to a request for pre-approval within one hour. (9) A Member who has an Emergency Medical Condition shall not be held liable for payment of subsequent screening and treatment needed to diagnose the specific condition or to stabilize the Member. 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. Based on this determination, Contractor will be liable for payment. (10) Contractor shall not refuse to cover Emergency Services based on any failure of an Emergency Department Provider, Hospital, or Fiscal Agent to notify a Member's Primary Care Provider of the Member's screening and treatment within ten (10) days of presentation for Emergency...
Sample 1Sample 2See All (9)
AutoNDA by SimpleDocs
Crisis, Urgent and Emergency Services. (1) Contractor may not require Prior Authorization for Emergency Services nor limit what constitutes an Emergency Medical Condition on the basis of lists of diagnoses or symptoms. (2) Contractor shall provide an after-hours call-in system adequate to triage Urgent Care and Emergency Service calls, consistent with OAR 410-141-3840. (3) As provided for in OAR 410-141-3840 and 42 CFR § 438.114, Contractor shall not deny and is required to pay for a claim for Emergency Services, regardless of whether the Provider that furnishes the services has a contract with Contractor.
Sample 1
Crisis, Urgent and Emergency Services. (1) Contractor may not require Prior Authorization for Emergency Services nor limit what constitutes an emergency medical conditionEmergency Medical Condition on the basis of lists of diagnoses or symptoms. (2) Contractor shall provide an after-hours call-in system adequate to Triagetriage Urgent Care and Emergency Service calls, consistent with OAR 410-141-3140. Contract # (XXXXXX) CCO 2.0 Contract Template Exhibit B – Statement of Work – Part 2 - Covered and Non-Covered Services Page 30 of 358 (3) As provided for in OAR 410-141-3140 and 42 CFR §438.114, Contractor shall cover andnot deny, but must pay for a claim for Emergency Services, regardless of whether the providerProvider that furnishes the services has a contract with Contractor, as provided for in OAR 410-141-3140. (4) Contractor is encouraged to establish agreements with Hospitals in its Service Area for the payment of emergency screening exams. (5) Contractor shall not deny payment for treatment obtained when a Member has an Emergency Medical Condition or Emergency Dental Condition, including cases in which the absence of immediate medical attention would not have had the outcomes specified in the definition of Emergency Medical Condition or
Sample 1

Related to Crisis, Urgent and Emergency Services

  • Emergency Services The parties recognize that in the event of a strike or lockout, situations may arise of an emergency nature. To this end, the Employer and the Union will agree to provide services of an emergency nature.

  • Emergency Services Leave (a) An Employee who engages in a voluntary emergency management activity is entitled to be absent without loss of pay from his or her employment for a total of 5 days per annum commencing at the start of each calendar year. For the avoidance of doubt, any days not utilised by the Employee by the end of the calendar year, do not carry over into the subsequent year. (b) Voluntary emergency management activity has the meaning provided by the FWA.

  • Emergency Service Leave Where employees' services are required for emergency operations by request from Provincial Emergency Programs or appropriate police authority, leave from work as required may be granted without loss of basic pay. If any remuneration, other than for expenses, is received, it shall be remitted to the Employer.

  • EMERGENCY SERVICE If you are unable to reach Administrator at 877.634.0964 and you require emergency repair, you may contact any manufacturer authorized service repair facility listed in Your phone book or online. Mail Administrator Your original repair bill along with the technician’s report and a copy of the Agreement to the address at the top of this Agreement for reimbursement. All coverage and exclusions in this Agreement will apply.

  • Emergency Situations If the condition is an emergency, this will be communicated to the Contractor with the request that corrections are to be accomplished immediately. The Contractor shall respond to the notice in emergency situations within twenty-four hours. If the Contractor fails to respond within this time limit, the Owner may correct the defect and charge the Contractor for the Work. If it is determined the complaint is not the responsibility of the Contractor, the Contractor shall be promptly paid for the cost of the corrective work. The Contractor shall give notice in writing to the Owner when corrections have been completed.

  • Agency of Human Services The Agency of Human Services is responsible for overseeing all contracts and grants entered by any of its departments, boards, offices and business units, however denominated. The Agency of Human Services, through the business office of the Office of the Secretary, and through its Field Services Directors, will share with any named AHS-associated party to this Agreement oversight, monitoring and enforcement responsibilities. Party agrees to cooperate with both the named AHS-associated party to this contract and with the Agency of Human Services itself with respect to the resolution of any issues relating to the performance and interpretation of this Agreement, payment matters and legal compliance.

  • Emergency Situation In the event of an emergency situation beyond our reasonable control, such as an "act of God," war, fire, or natural disaster, services involving your account could be available only in a modified or reduced form or could be entirely unavailable. Unless expressly prohibited by applicable law, you agree that we will have no liability to you for such modification, reduction, or unavailability of services caused by an emergency situation.

  • Emergency Operations 6:01 In the event of an emergency which could endanger the health or safety of the public, employees shall unite to meet the emergency and shall, until the danger has been brought under control, perform such duties as may be required of them regardless of their occupation.

  • Incident Event and Communications Management a. Incident Management/Notification of Breach - DST shall develop, implement and maintain an incident response plan that specifies actions to be taken when DST or one of its subcontractors suspects or detects that a party has gained material unauthorized access to Fund Data or systems or applications containing any Fund Data (the “Response Plan”). Such Response Plan shall include the following: i. Escalation Procedures - An escalation procedure that includes notification to senior managers and appropriate reporting to regulatory and law enforcement agencies. This procedure shall provide for reporting of incidents that compromise the confidentiality of Fund Data (including backed up data) to Fund via telephone or email (and provide a confirmatory notice in writing as soon as practicable); provided that the foregoing notice obligation is excused for such period of time as DST is prohibited by law, rule, regulation or other governmental authority from notifying Fund. ii. Incident Reporting - DST will use commercially reasonable efforts to promptly furnish to Fund information that DST has regarding the general circumstances and extent of such unauthorized access to the Fund Data.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following: 1. A personal illness, injury or medical emergency. 2. The death, illness, injury or medical emergency of an individual described in this Article. 3. An urgent matter that concerns an individual described in this Article. For the purposes of this Article, the individuals referred to in this Article are: - the employee’s spouse - a parent, step-parent or xxxxxx parent of the employee or the employee’s spouse - a child, step-child or xxxxxx child of the employee or the employee’s spouse - a grandparent, step-grandparent, grandchild or step-grandchild of the employee or of the employee’s spouse - the spouse of a child of the employee - the employee’s brother or sister - a relative of the employee who is dependent on the employee for care or assistance. An employee who wishes to take leave under this section shall advise his or her Hospital that he or she will be doing so. If the employee must begin the leave before advising the Hospital, the employee shall advise the Hospital of the leave as soon as possible after beginning it. An employee is entitled to take a total of 10 days’ leave under this section each year. If an employee takes any part of a day as leave under this section, the Hospital may deem the employee to have taken one day’s leave on that day for the purposes of this Article. The Hospital may require an employee who takes leave under this section to provide evidence reasonable in the circumstances that the employee is entitled to the leave. Upon the conclusion of an employee’s leave under this Article, the Hospital shall reinstate the employee to the position the employee most recently held with the Hospital, if it still exists, or to a comparable position, if it does not.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!