Open Clinical Dialogue. Nothing contained herein shall be construed to limit, prohibit or otherwise preclude PROVIDER from engaging in open clinical dialogue with any Member(s) or any designated representative of a Member(s) regarding: (a) any Medically Necessary or Medically Appropriate care, within the scope of PROVIDER’s practice, including but not limited to, the discussion of all possible and/or applicable treatments, including information regarding the nature of treatment, risks of treatment, alternative treatments or the availability of alternative treatments or consultations and diagnostic test, and regardless of benefit coverage limitations under the terms of the Plan(s)’ documents or medical policy determinations and whether such treatments are Covered Services under the applicable XXXXX benefit program designs; or (b) the process XXXXX uses on its own behalf or on behalf of Plan(s) to deny payment for a vision care service; or (c) the decision by XXXXX on its own behalf or on behalf of Plan(s) to deny payment for a vision care service. In addition, XXXXX and PROVIDER are prohibited, throughout the Term(s) of this Agreement, from instituting gag clauses for their employees, contractors, subcontractors, or agents that would limit the ability of such person(s) to share information with Plan(s) and/or any regulatory agencies regarding the Medical Assistance MCO Program(s) and the Medicare Program(s).
Appears in 2 contracts
Samples: Participating Provider Agreement, Participating Provider Agreement
Open Clinical Dialogue. Nothing contained herein shall be construed to limit, prohibit or otherwise preclude PROVIDER from engaging in open clinical dialogue with any Member(s) or any designated representative of a Member(s) regarding: (a) any Medically Necessary or Medically Appropriate care, within the scope of PROVIDER’s practice, including but not limited to, the discussion of all possible and/or applicable treatments, including information regarding the nature of treatment, risks of treatment, alternative treatments or the availability of alternative treatments or consultations and diagnostic test, and regardless of benefit coverage limitations under the terms of the Plan(s)’ documents or medical policy determinations and whether such treatments are Covered Services under the applicable XXXXX benefit program designs; or (b) the process XXXXX uses on its own behalf or on behalf of Plan(s) to deny payment for a vision care service; or (c) the decision by XXXXX on its own behalf or on behalf of Plan(s) to deny payment for a vision care service. In addition, XXXXX and PROVIDER are prohibited, throughout the Term(s) of this Agreement, from instituting gag clauses for their employees, contractors, subcontractors, or agents that would limit the ability of such person(s) to share information with Plan(s) and/or any regulatory agencies regarding the Medical Assistance MCO Program(s) and the Medicare Program(s).
Appears in 2 contracts
Samples: cvw1.davisvision.com, davisvision.com
Open Clinical Dialogue. Nothing contained herein shall be construed to limit, prohibit or otherwise preclude PROVIDER from engaging in open clinical dialogue with any Member(s) Members or any designated representative of a Member(s) ), regarding: (a) any Medically Necessary or Medically Appropriate care, within the scope of PROVIDER’s practice, including but not limited to, the discussion of all possible and/or applicable treatments, including information regarding the nature of treatment, risks of treatment, alternative treatments or the availability of alternative treatments or consultations and diagnostic testtests, and regardless of benefit coverage limitations under the terms of the Plan(s)’ documents or medical policy determinations and whether such treatments are Covered Services under the applicable XXXXX benefit program plan designs; or (b) the process XXXXX uses on its it own behalf or on behalf of Plan(s) to deny payment for a vision care service; or (c) the decision by XXXXX on its own behalf or on behalf of Plan(s) to deny payment for a vision care service. In addition, XXXXX and PROVIDER are prohibited, throughout the Term(s) of this Agreement, from instituting gag clauses for their employees, contractors, subcontractorssubcontractor, or agents that would limit the ability of such person(s) to share information with Plan(s) and/or any regulatory agencies regarding the Medical Assistance MCO Program(s) and the Medicare Program(s).
Appears in 1 contract
Samples: Participating Provider Agreement
Open Clinical Dialogue. Nothing contained herein shall be construed to limit, prohibit or otherwise preclude PROVIDER from engaging in open clinical dialogue with any Member(s) Members or any designated representative of a Member(s) regarding: ), regarding (a) any Medically Necessary or Medically Appropriate care, within the scope of PROVIDER’s practice, including but not limited to, the discussion of all possible and/or applicable treatments, including information regarding the nature of treatment, risks of treatment, alternative treatments or the availability of alternative treatments or consultations and diagnostic testtests, and regardless of benefit coverage limitations under the terms of the Plan(s)’ documents or medical policy determinations and whether such treatments are Covered Services under the applicable XXXXX benefit program plan designs; or (b) the process XXXXX uses on its own behalf or on behalf of Plan(s) to deny payment for a vision care service; or (c) the decision by XXXXX on its own behalf or on behalf of Plan(s) to deny payment for a vision care service. In addition, XXXXX and PROVIDER are prohibited, throughout the Term(s) of this Agreement, from instituting gag clauses for their employees, contractors, subcontractors, or agents that would limit the ability of such person(s) to share information with Plan(s) and/or any regulatory agencies regarding the Medical Assistance MCO Program(s) and the Medicare Program(s).
Appears in 1 contract
Samples: Participating Provider Agreement
Open Clinical Dialogue. Nothing contained herein shall be construed to limit, prohibit or otherwise preclude PROVIDER from engaging in open clinical dialogue with any Member(s) or any designated representative of a Member(s) ), regarding: (a) any Medically Necessary or Medically Appropriate care, within the scope of PROVIDER’s practice, including including, but not limited to, the discussion of all possible and/or applicable treatments, including information regarding the nature of treatment, risks of treatment, alternative treatments or the availability of alternative treatments or consultations and diagnostic testtests, and regardless of benefit coverage limitations under the terms of the Plan(s)’ documents or medical policy determinations and whether such treatments are Covered Services under the applicable XXXXX benefit program designs; or (b) the process XXXXX uses on its own behalf or on behalf of Plan(s) to deny payment for a vision care service; or (c) the decision by XXXXX on its own behalf or on behalf of Plan(s) to deny payment for a vision care service. In addition, XXXXX and PROVIDER are prohibited, throughout the Term(s) of this Agreement, from instituting gag clauses for their employees, contractors, subcontractors, or agents that would limit the ability of such person(s) to share information with Plan(s) and/or any regulatory agencies regarding the Medical Assistance MCO Program(s) and the Medicare Program(s).
Appears in 1 contract
Samples: Participating Provider Agreement
Open Clinical Dialogue. Nothing contained herein shall be construed to limit, prohibit or otherwise preclude PROVIDER from engaging in open clinical dialogue with any Member(s) Members, or any designated representative of a Member(s) regarding: (a) any Medically Necessary or Medically Appropriate care, within the scope of PROVIDER’s practice, including but not limited to, to the discussion of all possible and/or applicable treatments, including information regarding the nature of treatment, risks of treatment, alternative treatments or the availability of alternative treatments or consultations and diagnostic test, and regardless of benefit coverage limitations under the terms of the Plan(s)’ documents or medical policy determinations and whether such treatments are Covered Services under the applicable XXXXX benefit program plan designs; or (b) the process XXXXX uses on its own behalf or on behalf of Plan(s) to deny payment for a vision care serviceare services; or (c) the decision by XXXXX on its own behalf or on behalf of Plan(s) to deny payment for a vision care service. In additionThroughout the Term of this Agreement, XXXXX and PROVIDER are prohibited, throughout the Term(s) of this Agreement, prohibited from instituting gag clauses for their employees, contractors, subcontractors, or agents that would limit the ability of such person(s) to share information with Plan(s) and/or any or all regulatory agencies regarding the PA Medical Assistance MCO Program(s) and the Medicare Program(s).
Appears in 1 contract
Samples: davisvision.com
Open Clinical Dialogue. Nothing contained herein shall be construed to limit, prohibit or otherwise preclude PROVIDER from engaging in open clinical dialogue with any Member(s) or any designated representative of a Member(s) regardingregardin: (a) any Medically Necessary or Medically Appropriate care, within the scope of PROVIDER’s practice, including but not limited to, the discussion of all possible and/or applicable treatments, including information regarding the nature of treatment, risks of treatment, alternative treatments or the availability of alternative treatments or consultations and diagnostic test, and regardless of benefit coverage limitations under the terms of the Plan(s)’ documents or medical policy determinations and whether such treatments are Covered Services under the applicable XXXXX or HCSC benefit program designs; or (b) the process XXXXX uses on its own behalf or on behalf of Plan(s) to deny payment for a vision care service; or (c) the decision by XXXXX on its own behalf or on behalf of Plan(s) to deny payment for a vision care service. In addition, XXXXX and PROVIDER are prohibited, throughout the Term(s) of this Agreement, from instituting gag clauses for their employees, contractors, subcontractors, or agents that would limit the ability of such person(s) to share information with Plan(s) and/or any regulatory agencies regarding the Medical Assistance MCO Program(s) and the Medicare Program(s).
Appears in 1 contract
Samples: Participating Provider Agreement
Open Clinical Dialogue. Nothing contained herein shall be construed to limit, prohibit prohibit, or otherwise preclude PROVIDER from engaging in open clinical dialogue with any Member(s) or any designated representative of a Member(s) regarding: (a) any Medically Necessary or Medically Appropriate care, within the scope of PROVIDER’s practice, including but not limited to, to the discussion of all possible and/or applicable treatments, including information regarding the nature of treatment, risks of treatment, alternative treatments or the availability of alternative treatments or consultations and diagnostic test, and regardless of benefit coverage limitations under the terms of the Plan(s)’ documents or medical policy determinations and whether such treatments are Covered Services under the applicable XXXXX benefit program designs; or (b) the process XXXXX uses on its own behalf or on behalf of Plan(s) to deny payment for a vision care service; or (c) the decision by XXXXX on its own behalf or on behalf of Plan(s) to deny payment for a vision care service. In addition, XXXXX and PROVIDER are prohibited, prohibited throughout the Term(s) of this Agreement, Agreement from instituting gag clauses for their employees, contractors, subcontractors, or agents that would limit the ability of such person(s) to share information with Plan(s) and/or any regulatory agencies regarding the Medical Assistance MCO Program(s) and the Medicare Program(s).
Appears in 1 contract
Samples: Participating Provider Agreement