Medical Management of Transplant Services Sample Clauses

Medical Management of Transplant Services. (a) All Transplant Services shall be provided in accordance with the provisions of PacifiCare’s MM Program including without limitation, the provisions of PacifiCare’s Provider Manual. Specifically, but without limitation, authorization of the evaluation of the recipient prior to listing for transplantation, the actual transplant itself, and post transplant care up to 365 days post discharge, must be obtained from PacifiCare’s NPTN Medical Director, or his or her designee, prior to the provision of Transplant Services. (b) PacifiCare shall be responsible for providing, coordinating and arranging for the Medical Management of NPTN Transplant Services for which it is financially responsible. Medical Group shall be responsible for providing, coordinating and arranging Transplant Services for which it is financially responsible, subject to coordination with PacifiCare pursuant to the terms of PacifiCare’s MM Program. (c) Transplant Services provided by Medical Group or pursuant to a Medical Group referral that are not authorized by PacifiCare prior to the provision of the Transplant Services shall constitute Non-NPTN Transplant Services and be the sole financial responsibility of the Medical Group regardless of whether such Transplant Services would have otherwise constituted NPTN Transplant Services.
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Medical Management of Transplant Services. Medical management for any service related to the evaluation of, actual transplant of and follow-up care (within contractual time frames) of any solid organ (except skin and cornea) or transplantation of any bone marrow, peripheral stem cell or cord blood component shall be the sole responsibility of PacifiCare. The Provider Manual provides additional guidelines and policies and procedures governing the management of Transplant Services. Authorization of the evaluation of the recipient prior to listing for transplantation, the actual transplant itself, and post transplant care services up to 365 days post discharge, must be obtained from PacifiCare’s NPTN Medical Director, or his designee, prior to initiation of services.
Sample 1Sample 2
Medical Management of Transplant Services. (i) All Transplant Services shall be provided in accordance with the provisions of PacifiCare’s MM Program. Specifically, but without limitation, authorization of the evaluation of the recipient prior to listing for transplantation, the actual transplant itself, and post transplant care up to three hundred sixty-five (365) days post discharge, must be obtained from PacifiCare’s NPTN Medical Director, or his or her designee, prior to the provision of Transplant Services. (ii) PacifiCare shall be responsible for providing, coordinating and arranging for the Medical Management of all Transplant Services regardless of whether PacifiCare or the Medical Group is financially responsible for the provision of such Transplant Services. Medical Group specifically agrees that even Transplant Services for which Medical Group is financially responsible must be provided in accordance with PacifiCare’s MM Program using PacifiCare’s designated NPTN Participating Providers and that Medical Group’s failure to comply with the foregoing may place PacifiCare in breach of its agreements with employer groups or Participating Providers and may be inconsistent with the provisions of PacifiCare’s Subscriber Agreements and Evidences of Coverage. (iii) Transplant Services provided by Medical Group or pursuant to a Medical Group referral that are not authorized by PacifiCare prior to the provision of the Transplant Services shall constitute Non-NPTN Transplant Services.
Sample 1

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