Outpatient Services. Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.
Outpatient Services. Medical treatments or services provided or ordered by a physician for the Insured when the Insured is not admitted at a Hospital. Outpatient services may include services performed in a hospital or emergency room.
Outpatient Services. The following services are covered only at the Primary Care Provider’s office[selected by a [Member], or elsewhere [upon prior written Referral by a [Member]'s Primary Care Provider ]:
1. Office visits during office hours, and during non-office hours when Medically Necessary and Appropriate.
2. Home visits by a [Member]'s Primary Care Provider.
3. Periodic health examinations to include:
a. Well child care from birth including immunizations;
b. Routine physical examinations, including eye examinations;
c. Routine gynecologic exams and related services;
d. Routine ear and hearing examination; and
e. Routine allergy injections and immunizations (but not if solely for the purpose of travel or as a requirement of a [Member]'s employment).
Outpatient Services. Outpatient services are defined as those preventive, diagnostic, therapeutic, rehabilitative, surgical, mental health, facility services for dental, and Emergency Services received by a patient through an outpatient/ambulatory care facility for the treatment of a disease or injury for a period of time generally not exceeding twenty- four (24) hours. Outpatient or ambulatory care facilities include: (a) Hospital Outpatient Departments, (b) Diagnostic/Treatment Centers, (c) Ambulatory Surgical Centers, (d) Emergency Rooms (ERs), (e) End Stage Renal Disease (ESRD) Clinics and (f) Outpatient Pediatric AIDS Clinics (OPAC). The CONTRACTOR shall:
4.2.19.1. Refer to the Medicaid Managed Care Policy and Procedure Guide and applicable manuals for additional details regarding this Benefit/service coverage requirement.
Outpatient Services. The following services are covered [only] at the Primary Care Physician’s office [or other Network Facility or Practitioner’s office] selected by a [Member][, or elsewhere upon prior written Referral by a [Member]'s Primary Care Physician]:
1. Office visits during office hours, and during non-office hours when Medically Necessary and Appropriate.
2. Home visits by a [Member]'s Primary Care Physician.
3. Preventive Care, including but not limited to Periodic health examinations such as:
a. Well child care from birth including immunizations;
b. Routine physical examinations, including eye examinations;
c. Routine gynecologic exams and related services;
d. Routine ear and hearing examination; and
e. Routine allergy injections and immunizations (but not if solely for the purpose of travel or as a requirement of a [Member]'s employment).
Outpatient Services. The following services are covered [only] at the Primary Care Physician’s office [or Health Center] [or other Network Facility or Practitioner’s office] selected by a [Member][, or elsewhere upon prior written Referral by a [Member]'s Primary Care Physician [or Health Center] [or the Care Manager]]:
1. Office visits during office hours, and during non-office hours when Medically Necessary and Appropriate.
2. Home visits by a [Member]'s Primary Care Physician.
3. Periodic health examinations to include:
a. Well child care from birth including immunizations;
b. Routine physical examinations, including eye examinations;
c. Routine gynecologic exams and related services;
d. Routine ear and hearing examination; and
e. Routine allergy injections and immunizations (but not if solely for the purpose of travel or as a requirement of a [Member]'s employment).
Outpatient Services. Benefits for outpatient mental health care services include the outpatient treatment of mental illness by a hospital, a physician or another eligible provider. Attention deficit/hyperactivity disorder (ADHD) is classified as a mental health condition. Treatments for ADHD are eligible under mental health care benefits including medication checks by a Provider other than the Member’s PCP. However, medication checks provided by a Member’s PCP are considered medical visits.
Outpatient Services. Outpatient services including but not limited to: assessment, stabilization, treatment planning, discharge planning, verbal therapies, education, symptom management, case management services, crisis intervention and outreach services, chlozapine monitoring and collateral services as certified by OMH. Services may be provided in-home, office or the community. Services may be provided by licensed OMH providers or by other providers of mental health services including clinical psychologists and physicians. For further information regarding service coverage consult the following MMIS Provider Manuals: Clinic, Ambulatory Services for Mental Illness (Clinic Treatment Program), Clinical Psychology, and Physician (Psychiatric Services). Enrollees must be allowed to self-refer for one (1) mental health assessment from a Contractor's Participating Provider in a twelve (12) month period. In the case of children, such self-referrals may originate at the request of a school guidance counselor or similar source. Services provided through OMH designated clinics for Enrollees with a clinical diagnosis of SED are covered by Medicaid fee-for-service. APPENDIX K October 1, 2004 K-25
Outpatient Services. ASAM Level 1 – means outpatient drug free (ODF) services are provided to adults and youth experiencing a SUD who meet medical necessity for this level of care, determined by an LPHA or physician’s diagnosis and County-based ASAM criteria. Services shall be less than nine (9) hours per week for adults and less than six (6) hour per week for adolescents.
Outpatient Services. Outpatient mental health services place priority on restoring the Member to his/her level of functioning prior to the onset of acute symptoms or to achieve a clinically appropriate level of stability as determined by GHC’s Medical Director, or his/her designee. Treatment for clinical conditions may utilize psychiatric, psychological and/or psychotherapy services to achieve these objectives.
