Medical Coordination. When the BENEFICIARY requires Medical Assistance, previously requested by him and payable by him, the Medical Team of The Company will coordinate:
1. An appointment with a Professional Physicians at his/her office.
2. A visit from a Professional Physician at the domicile of the BENEFICIARY.
3. A checkup or visit at a hospital or specialty clinic. The medical Team of the Company will not issue a diagnosis but at the request of the BENEFICIARY and to be paid by him/her, it will arrange for the necessary attention. The COMPANY will provide this service in the main cities of Mexico. Anywhere else it will do everything possible to assist the BENEFICIARY in contacting a doctor, hospital or clinic within a reasonable time. The COMPANY will not be responsible with regards to any medical attention or lack of it provided or not by any physician, doctor, hospital or clinic.
Medical Coordination. Insurer shall coordinate care with Enrollees’ other Florida Healthy Kids health insurance carriers. Insurer shall enter into Data sharing agreements and shall exchange Data with FHKC’s other insurance carriers as directed by FHKC.
Medical Coordination. Both parties agree to establish a process for clinical staff to communicate on a regular basis to review the care coordination plans and status of mutually served beneficiaries in accordance with applicable privacy laws such as HIPAA, the Mental Health Code and 42 CFR Part 2. This may involve the sharing of written documents and verbal reports. Both parties will collaborate on development of referral procedures and effective means of communicating the need for individual referrals. The MIHP provider will provide the MHP with names of MHP beneficiaries receiving MIHP services on a regular basis, utilizing a standardized form. Communication may include assessment/screening results, the plan of care, and discharge summaries upon request. The MIHP and MHP will accept and use the MDHHS behavioral health consent form (Consent to Share Behavioral Health Information for Care Coordination Purposed form [DCH-3927]) to disclose medical information protected under the Mental Health Code or substance use disorder information under 42CFR Part 2.
Medical Coordination. Both parties agree to establish a process for clinical staff to communicate on a regular basis to review the plans and status of mutually served beneficiaries. This may involve sharing of written documents and verbal reports. Both parties will collaborate on development of referral procedures and effective means of communicating the need for individual referrals. The MIHP provider will provide the MHP with names of MHP beneficiaries receiving MIHP services on a regular basis utilizing a standardized form. Communication may include assessment/screening results and plan of care documents upon request.
Medical Coordination. In order to coordinate the appropriate delivery of health care services to Medicaid enrollees, clarity regarding the respective responsibility is necessary. Both parties will develop referral procedures and effective means of communicating the need for individual referrals. In addition, both the Health Plan and CMHSP acknowledge respective individual responsibilities as listed below: Habilitation and rehabilitation services: Habilitation services means those services designed to assist Medicaid enrollees in the development of skills and capacities they have never possessed, (i.e., predominantly in the functioning areas of self-care and/or activities of daily living), and to maintain capacities attained for the first time. Habilitation services are the responsibility of the CMHSP. Rehabilitation services are designed to assist Medicaid enrollees in restoring those self-care skills they once possessed, and is the responsibility of the Health Plan.
Medical Coordination. In order to coordinate the appropriate delivery of health care services to Medicaid enrollees, clarity regarding the respective responsibility is necessary. Both parties will develop referral procedures and effective means of communicating the need for individual referrals. It is the responsibility of Health Plans to provide or arrange for a limited number of outpatient visits (20 visits). The Health Plan may contract with the CMHSP to provide this benefit. Payment for these services are the responsibility of the Health Plan. It is the responsibility of the CMHSP to provide or arrange for all inpatient (including entry and exit from state facilities) services and specialty mental health services. Payment for these services will be the responsibility of the CMHSP and the Michigan Department of Community Health.
