Other Group Participating Providers. When an initial Provider Referral of a BlueLincs HMO Member is made to a Group Participating Provider for a specific diagnosis, Group agrees to obtain Prior Authorization or ensure that Prior Authorization is obtained for any additional services related to the treatment of that diagnosis in accordance with BlueLincs HMO's utilization management guidelines and protocols and BlueLincs HMO Member Benefits descriptions. These services may include but are not limited to: all inpatient hospital admissions; certain outpatient services; home health or hospice services; genetic testing; and advanced imaging services. For specific Prior Authorization requirements, Group shall call the number on the back of the BlueLincs HMO Member's identification card. Group shall follow the process set forth in Article VI of the Agreement to obtain or verify Prior Authorization.
Other Group Participating Providers. When an initial Provider Referral of a BlueLincs HMO Member is made to a Group Participating Provider for a specific diagnosis, the Group Participating Provider shall ensure that all subsequent Provider Referrals and/or Out of Network Requests relating to treatment of the diagnosis that led to the initial referral are completed. Except in a Medical Emergency or when authorized in advance by BlueLincs HMO, Group Participating Providers shall refer BlueLincs HMO Members to BlueLincs HMO Participating Providers only.
