Participating Providers. To find out if a Provider is a Participating Provider: • Check Our Provider directory, available at Your request; • Call the number on Your ID card; or • Visit our website at xxx.xxxxxx.xxx. The Provider directory will give You the following information about Our Participating Providers: • Name, address, and telephone number; • Specialty; • Board certification (if applicable); • Languages spoken; and • Whether the Participating Provider is accepting new patients.
Participating Providers. To find out if a Provider is a Participating Provider, and for details about licensure and training: • Check Our Provider directory, available at Your request; • Call the number on Your ID card; or • Visit our website at xxx.xxxxxxx.xxx.
Participating Providers. Participating Providers have a contract with a Medical Group in this plan’s network. With an HMO plan, there is generally no coverage for services from providers outside of your Medical Group. If a provider leaves your Medical Group, you will not have coverage for services received from that provider. See the Continuity of Care section for more information on how to continue treatment with a Non-Participating Provider.
Participating Providers are (i) physicians and health care professionals who are shareholders, partners or employees of Medical Group and (ii) physicians, medical groups, individual practice associations (“IPA”), health care professionals, hospitals, facilities and other providers of health care services or supplies that have entered into written contracts with PacifiCare, Medical Group or Hospital to provide Covered Services to Members pursuant to Managed Care Plans.
Participating Providers. Except in an Emergency or as otherwise required by law, PPG shall refer Members only to Participating Providers for Covered Services unless such services are not reasonably available from Participating Provider. In the event PPG or a Member Physician refers a Member to a non-Participating Provider, PPG agrees to be responsible for payment of claims incurred for the Covered Services rendered by such non-Participating Provider, and PPG agrees to hold harmless the Member for such claims. If FHS is obligated to pay for services which FHS determines are the financial responsibility of PPG or which it would not otherwise be obligated to pay, FHS shall have the right to deduct the cost of such services from any amounts due to PPG. FHS agrees not to deduct any amount as set forth in this Section without first giving PPG ten (10) days prior written notice during which time PPG shall have the opportunity to show cause why such amount should not be deducted by FHS.
Participating Providers. STANDARD FOR COMPLIANCE: MCOs networks will include all the provider types necessary to furnish the benefit package, to assure appropriate and timely health care to all enrollees, including those with chronic illness and/or disabilities. Physical accessibility is not limited to entry to a provider site, but also includes access to services within the site, e.g. exam tables and medical equipment. SUGGESTED METHODS FOR COMPLIANCE
Participating Providers. Contractor shall maintain a provider network in compliance with the requirements the Administrative Requirements and Performance Guarantees. Participating providers associated with the provision of Services for this Contract:
i. Must not charge an office visit copay;
ii. Must complete Claim forms on behalf of the Member, unless the Member requests otherwise;
iii. Must submit to Contractor a request for a cost estimate, or pre-treatment estimate, at the request of the Member; and
iv. Must maintain accurate records with Contractor. This includes, but is not limited to, office address and telephone records, hours of operation, and whether or not the provider is accepting new patients.
Participating Providers non-participating Providers, institutions, facilities or agencies are neither agents nor employees of HMO. Neither HMO nor any Member of HMO is an agent or employee of any Participating Provider, non-participating Provider, institution, facility or agency. Members shall not include HMO as a party in any legal proceeding alleging medical malpractice.
Participating Providers. Institutional and/or non-institutional health care providers, including PHO Providers, which or who are under contract, directly or indirectly, with the Plan to provide Covered Services to Plan Members.
Participating Providers. To obtain full coverage from “managed” benefit plans beneficiaries must use plan participating physicians and ancillary service providers. The Resident agrees to use plan participating providers unless the Facility is notified to the contrary, and agrees to pay privately for requested non-covered non-participating providers’ services.
