Designated Covered Services Sample Clauses

Designated Covered Services. Provider shall have the right to provide Designated Covered Services to Enrollees through one or more Provider Affiliates only if authorized to do so in writing by THP. THP may revoke such consent if the Provider Affiliate fails to comply with the terms and conditions of this Agreement imposed on Provider Affiliates. If requested by THP, each Provider Affiliate will execute and deliver to THP the form of Agreement, Release and Immunity attached to this Agreement as Exhibit 3. Where --------- appropriate, all references to Provider in this Agreement shall be deemed to include all Provider Affiliates. Provider shall not authorize, permit or allow any Designated Covered Services to be delivered or provided by anyone other than Provider or a Provider Affiliate.

Designated Covered Services. All services described in Exhibit 1 to the Agreement. --------- Prior Authorization Requirements: All Designated Covered Services require Prior Authorization with the exception of (1) Emergency Care, (2) services delivered by a Primary Care Provider to his/her assigned Enrollees that are reimbursed on a fixed monthly fee or other method of reimbursement that does not require the filing of a claim as a condition to payment and (3) those Designated Covered Services listed as not requiring Prior Authorization in THP's provider manual. Emergency Care is not subject to Prior Authorization; however, Provider is required to give notice to THP within twenty-four (24) hours after the provision of Emergency Care or any Referral for Emergency Care. Once the Enrollee has been stabilized, any subsequent care is subject to Prior Authorization requirements.

Designated Covered Services. Provider shall provide Medically/Psychologically Necessary Designated Covered Services to all Enrollees entitled to coverage for such services under a Plan Contract. Provider warrant that the Designated Covered Services described in Exhibit 1 and all Addenda are within the scope of Provider's license and/or training and that Provider is professionally or otherwise qualified to provide such Designated Covered Services to Enrollees. Provider shall provide Designated Covered Services to Enrollees in accordance with a plan of care that has been approved by TBH and shall assist TBH and the Case Manager, as requested, in the establishment of such plan of care. If so indicated in Exhibit 1, Provider will serve as a Case Manager or provide one or more Mobile Crisis Units to perform those functions required under TBH Policies and TBH Procedures.