Out-of-Network Services. (A) If the Contractor’s network of Participating Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Participating Provider for the Enrollee for as long as the Contractor is unable to provide them. (B) The Contractor shall require Non-Participating Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the network.
Appears in 10 contracts
Samples: Prepaid Mental Health Plan, Prepaid Mental Health Plan Contract, Prepaid Mental Health Plan Contract
Out-of-Network Services. (A) If the Contractor’s network of Participating Network Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Participating Network Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Participating Network Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the network.
Appears in 9 contracts
Samples: Accountable Care Organization (Aco) Contract, Accountable Care Organization (Aco) Contract, Integrated Care Contract
Out-of-Network Services. (A) If the Contractor’s network of Participating Network Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Participating Network Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Participating Network Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the network.
Appears in 7 contracts
Samples: Prepaid Mental Health Plan (Pmhp) Contract, Prepaid Mental Health Plan (Pmhp) Contract, Prepaid Mental Health Plan (Pmhp) Contract
Out-of-Network Services. (A) If the Contractor’s network of Participating Network Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Participating Network Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Participating Network Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the networkby a Network Provider.
Appears in 4 contracts
Samples: McNa Dental Contract, Premier Access Contract Prepaid Ambulatory Health Plan (Pahp), Prepaid Ambulatory Health Plan (Pahp) Contract
Out-of-Network Services. (A) If the Contractor’s network of Participating Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Participating Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Participating Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the services were furnished within the networkby a Participating Provider.
Appears in 4 contracts
Samples: Premier Access Chip Contract, Prepaid Ambulatory Health Plan (Pahp) Contract, Chip Premier Access Dental Contract Amendment 2
Out-of-Network Services. (A) If the Contractor’s network of Participating Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular Enrollee, the Contractor shall adequately and timely cover these services using a Non-Participating Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require use reasonable efforts to ensure that (i) Non-Participating Providers to coordinate with the Contractor with respect to payment and ensure that (ii) the cost to the Enrollee is no greater than it would be if the services were furnished within the networkby a Participating Provider.
Appears in 2 contracts
Samples: Chip Dentaquest Amendment 2, Contract
Out-of-Network Services. (A) If the Contractor’s network of Participating Providers is unable to provide Medically Necessary Covered Services under this Contract to a particular an Enrollee, the Contractor shall adequately and timely cover these services using a Non-Participating Provider for the Enrollee for as long as the Contractor is unable to provide them.
(B) The Contractor shall require Non-Participating Providers to coordinate with the Contractor with respect to payment and ensure that the cost to the Enrollee is no greater than it would be if the cost of the services were furnished within the network.
Appears in 1 contract
Samples: Contract
