In Network Referrals and Transfers. Provider shall use its best efforts to refer Covered Persons to Participating Providers within the Network.
In Network Referrals and Transfers. Provider shall utilize Network/Participating Providers, and shall refer and transfer Covered Individuals to Network/Participating Providers unless Provider has obtained a written acknowledgement (e.g. written waiver form) from the Covered Individual, prior to the provision of the service, indicating that (1) the Covered Individual was advised that no coverage, or only out-of-network coverage would be available from Plan and (2) the Covered Individual agreed to be financially responsible for additional costs related to such service. Additionally, Provider represents and warrants that Provider does not give, provide, condone or receive any incentives or kickbacks, monetary or otherwise, in exchange for the referral of a Covered Individual, and if a Claim for payment is attributable to an instance in which Provider provided or received an incentive or kickback in exchange for the referral, such Claim shall not be payable and, if paid in error, shall be refunded to Anthem.
In Network Referrals and Transfers. Provider shall when medically appropriate refer and transfer Covered Individuals to Network/Participating Providers. Provider acknowledges that HMO Health Benefit Plans require, as a condition of coverage, that a Covered Individual be admitted by, or on the authorization of, the Plans Network/Participating Provider responsible for the Covered Individual’s care. Provider agrees to obtain telephone authorization from the Plans Network/Participating Provider for any unscheduled admissions and prior to rendering services in the emergency room, except when an emergency which precludes prior authorization has been determined by the physician in the emergency room. If prior authorization cannot be obtained, Provider agrees to notify Plans Network/Participating Provider no later than the next working day.
In Network Referrals and Transfers. Provider agrees to refer, admit or arrange for admission of Members to other Participating Providers in all circumstances except (i) when authorization has been granted in advance by Anthem to refer to a non- Participating Provider, or (ii) when necessary due to an Emergency Condition. If Provider under any circumstance refers, admits or arranges for admission of Members to non- Participating Providers, and the Health Services were not authorized by Plan or due to non-Emergency Conditions, then Provider shall provide the Member prior written notice of the following information:
In Network Referrals and Transfers. Provider shall, when medically appropriate, refer and transfer Covered Individuals to Network Participating Providers. Provider acknowledges that as a condition to coverage and payment for services provided to a Covered Individual, the services must be authorized by Anthem, or by the Network Participating Provider responsible for the Covered Individual's care. Provider agrees to obtain telephone authorization from the Network Participating Provider for any unscheduled Health Services. If prior authorization cannot be obtained, Provider agrees to notify the Network Participating Provider no later than the next working day.
