Common use of Payment for Out of Network Providers Clause in Contracts

Payment for Out of Network Providers. For the out-of-network services specified in subparagraph (a), the MCO must coordinate with the out-of-network provider to ensure that the cost to the enrollee is no greater than it would be if the services were provided in- network. If the out-of-network provider lacks the capacity to conduct the transaction using the enrollee’s POWER card, the provider must be instructed to bill the MCO and the MCO must reimburse the out-of-network provider with funds from the enrollee’s POWER Account.

Payment for Out of Network Providers. For the out-of-network services specified in subparagraph (a), the MCO must coordinate with the out-of-network provider to ensure that the cost to the enrollee is no greater than it would be if the services were provided in- network. If the out-of-network provider lacks the capacity to conduct the transaction using the enrollee’s POWER card, the provider must be instructed to bill the MCO and the MCO must reimburse the out-of-network provider with funds from the enrollee’s POWER Account.in-