Hospital Admissions. Whenever IPA determines that a Subscriber on IPA's eligibility list requires Hospital Services which are not Emergency Services, IPA shall arrange for such Hospital admissions and outpatient surgeries through the IPA's Utilization Review Committee and its developed utilization review program. IPA and its Member Physicians shall not serve as admitting physicians for any Subscriber without such prior approval except in the event that Emergency Services are required. If IPA or a Member Physician admits a Subscriber to a Hospital for Emergency Services, IPA shall notify PacifiCare of such admission within the time frames as required in the PacifiCare Provider Policies and Procedures Manual, attached hereto as Attachment D and incorporated in full herein by reference. Admissions for Emergency Services or Urgently Needed Services shall be made to hospitals contracting with PacifiCare, if possible.
Hospital Admissions. If you are admitted to a non-Plan Hospital, you, your Parent/Guardian, Financially Responsible Person or someone else must notify us within the later of forty-eight (48) hours of a Member’s hospital admission or on the first working day following the admission unless it was not reasonably possible to notify us within that time.
Hospital Admissions. In recognition of the need for coordination, continuity, and quality of care of Covered Services provided to Medical Group Members, Medical Group agrees to utilize Hospital(s) as provider of Hospital Services for Medical Group Members, subject to the following exceptions:
(i) Medical Group Members admitted for Emergency Services or Urgently Needed Services; and
(ii) Medical Group Members requiring Hospital Services not available at Hospital.
Hospital Admissions. In cases where a Covered Person requires a non-emergency hospital admission by Physician, Physician agrees to secure authorization for such admission from the Medical Director, or his/her designee, prior to the admission if such prior authorization is required under the applicable Plan. Physician understands that any extension of the initial covered length of stay may require prior authorization from the Medical Director, or his/her designee, under the applicable Plan. Physician shall abide by any utilization review protocols established for the applicable Plan with respect to hospital admissions; provided, however, Physician and VIVA Health agree that all clinical decisions shall ultimately be decided by Physician.
Hospital Admissions. In recognition of the need for coordination, continuity and quality of care of Covered Services provided to Medical Group Members and to ensure continuity and quality of care, Medical Group agrees to utilize Hospital(s) as the provider of Hospital Services for Medical Group Members, subject to the following exceptions:
(i) Medical Group Members admitted for Emergency Services or Urgently Needed Services; and
(ii) Medical Group Members requiring Hospital Services not available at Hospital.; and
(iii) Medical Group Members directed to any other Health Plan Participating Provider in accordance with Health Plan's Utilization Management Program. Notwithstanding the foregoing, Medical Group Member requests for treatment at another Health Plan Participating Provider may be granted due to limited Hospital(s) bed capacity or if such request is in the Member's best interest, as determined by Health Plan.
Hospital Admissions. FARA shall, unless otherwise set forth in this agreement or an attachment hereto, require that Qualified Participants of RCN requiring admission to a Participating Hospital be considered for admission in accordance with the policies and procedures of Participating Hospitals.
Hospital Admissions. If you are admitted to a non-Plan Hospital, you, your Parent/Guardian, Financially Responsible Person or someone else must notify us within the later of forty-eight (48) hours of a Member’s hospital admission or on the first working day following the admission unless it was not reasonably possible to notify us within that time. Getting Assistance from Our Advice Nurses Our advice nurses are registered nurses (RNs) specially trained to help assess clinical problems and provide clinical advice. They can help solve a problem over the phone and instruct you on self-care at home, when appropriate. If the problem is more severe and you need an appointment, they will help you get one. If you are not sure you are experiencing a medical emergency, or for Urgent Care Services for symptoms such as a sudden rash, high fever, severe vomiting, ear infection or sprain, you may call our advice nurses at 0-000-000-0000 or 711 (TTY). You may also call 0-000-000-0000 from anywhere in the United States, Canada, Puerto Rico or the Virgin Islands. Getting a Second Opinion You are welcome to receive a second medical opinion from a Plan Physician. We will assist you to arrange an appointment for a second opinion upon request. Receiving Care in Another Kaiser Foundation Health Plan Service Area You may receive covered Services from another Xxxxxx Foundation Health Plan, if the Services are provided, prescribed, or directed by that other plan, and if the Services would have been covered under this EOC. Covered Services are subject to the terms and conditions of this EOC, including prior authorization requirements, the applicable Copayments, Coinsurance and/or Deductibles shown in the Summary of Services and Cost Shares and the exclusions, limitations and reductions described in this EOC. For more information about receiving care in other Kaiser Foundation Health Plan service areas, including availability of Services, and provider and facility locations, please call our Away from Home Travel Line at 000-000-0000. Information is also available online at xx.xxx/xxxxxx.
Hospital Admissions. In recognition of the need for coordination of Covered Services provided to Medical Group Members and to ensure continuity and quality of care, Medical Group agrees to utilize Hospital as the provider of Hospital Services for Medical Group Members, subject to the following exceptions:
(i) Medical Group Members admitted for Emergency Services or Urgently Needed Services;
(ii) Medical Group Members requiring Hospital Services not available at Hospital; and
(iii) Medical Group Members directed to any other PacifiCare Participating Provider in accordance with PacifiCare's Utilization Management Program. Notwithstanding the foregoing, Medical Group Member requests for treatment at another PacifiCare Participating Provider may be granted due to limited Hospital bed capacity or if such request is in the Member's best interest, as determined by PacifiCare.
Hospital Admissions. The Provider is expected to be responsive to the needs of those coming out of hospital to facilitate smooth and timely discharge. The Provider will work with the Hospital Assessment and Community Discharge Team to facilitate smooth and timely discharge and deliver interim care plans at short notice, often on the same day but within 24 hours as a maximum. The Provider shall carry out an assessment with support of the trusted assessors based at the hospital and complete an interim care plan in conjunction with the Hospital Assessment and Community Discharge Team. If the Provider supported the service user prior to a hospital visit, then the same Provider shall aim to continue supporting that individual upon discharge wherever possible to ensure continuity of care. In rare circumstances where the Provider can no longer support or meet the needs of the individual, the Provider will notify the Council as soon as possible explaining the rationale for no longer being able to provide care for the individual. Once the individual has been discharged and is settled, the Provider will develop the interim care plan with the service user into a full service plan. If there are problems with the placement the relevant social worker should be contacted immediately. Providers shall notify the Hospital Discharge team and the Council’s Adult Placement team when there has been an inappropriate discharge and complete the Discharge Alert form. Upon admission into hospital the Provider will inform: ▪ the individual’s next of kin/a named representative as soon as possible ▪ the Council verbally via email within 24hours The Provider will remain in contact with the hospital throughout the duration of the individual’s admission.
Hospital Admissions. 3.7.1 HC shall admit Enrollees in need of inpatient hospital care only to Participating Hospitals. HC shall obtain authorization from ABCHP prior to any non-emergency hospital admission of an Enrollee. Such authorization may be by telephone.
3.7.2 In cases in which an emergency admission is required, HC agrees to obtain authorization from ABCHP as soon as practical. Emergency admissions may be authorized by telephone. If authorization cannot be obtained prior to an emergency admission, HC agrees to notify ABCHP as soon as possible, but in no event later than twenty-four (24) hours or the next normal work day after admission.
