Common use of Non-Participating Providers Clause in Contracts

Non-Participating Providers. 1. The Contractor shall be responsible for developing and advising its enrollees and where applicable, authorized persons of procedures for obtaining emergency services, including emergency dental services, when it is not medically feasible for enrollees to receive emergency services from or through a participating provider, or when the time required to reach the participating provider would mean risk of permanent damage to the enrollee's health. The Contractor shall bear the cost of providing emergency service through non- participating providers. 2. Non-contracted hospitals providing emergency services to Medicaid or NJ FamilyCare Members enrolled in the managed care program shall accept, as payment in full, 90% of the amounts that the non-contracted hospitals or non-participating provider of emergency services would receive from New Jersey Medicaid for the emergency services and/or any related hospitalization as if the beneficiary were enrolled in New Jersey fee-for-service Medicaid.

Non-Participating Providers. 1. The Contractor contractor shall be responsible for developing and advising its enrollees and where applicable, authorized persons of procedures for obtaining emergency services, including emergency dental services, when it is not medically feasible for enrollees to receive emergency services from or through a participating provider, or when the time required to reach the participating provider would mean risk of permanent damage to the enrollee's ’s health. The Contractor contractor shall bear the cost of providing emergency service through non- non-participating providers. 2. Non-contracted hospitals providing emergency services to Medicaid or NJ FamilyCare Members members enrolled in the managed care program shall accept, as payment in full, 90% of the amounts that the non-contracted hospitals or non-participating provider of emergency services would receive from New Jersey Medicaid for the emergency services and/or any related hospitalization as if the beneficiary were enrolled in New Jersey fee-for-service Medicaid.