Common use of Non-Participating Providers Clause in Contracts

Non-Participating Providers. It is understood that in some instances Participants will require specialty care not available from a Participating Provider and that the FIDA Plan will arrange that such items and services be provided by a Non- Participating Provider. In such event, the FIDA Plan will promptly negotiate an agreement (“Single Case Agreement”) with a Non-Participating Provider at the applicable Medicaid or Medicare Fee-For-Service rate to treat the Participant until a qualified Participating Provider is available. The FIDA Plan shall make best efforts to have any Non-Participating Provider billing for services be enrolled in the Medicare program or New York State Medicaid program, as appropriate and in the same manner as Participating Providers under Section 2.8.1.2, prior to paying a claim.

Non-Participating Providers. It is understood that in some instances Participants will require specialty care not available from a Participating Provider and that the FIDA Plan will arrange that such items and services be provided by a Non- Participating Provider. In such event, the FIDA Plan will promptly negotiate an agreement (“Single Case Agreement”) with a Non-Participating Provider at the applicable Medicaid or Medicare Fee-For-For- Service rate to treat the Participant until a qualified Participating Provider is available. The FIDA Plan shall make best efforts to have any Non-Non- Participating Provider billing for services be enrolled in the Medicare program or New York State Medicaid program, as appropriate and in the same manner as Participating Providers under Section 2.8.1.2, prior to paying a claim.