Pharmacy Behavioral Health Generic Sample Clauses

Pharmacy Behavioral Health Generic. An appeal submitted by a Provider on the Member’s behalf is to be reported under Member Appeal Activity. Member Appeal Activity COS Category of Service (COS) Description Beginning Balance Ending Balance Received Resolved Appeals Extended by 14 Calendar Days Total Expedi xxx Non Expedi xxx Total Expedited Resolved in 3 Working Days Non Expedited % Resolved in 30 Calendar Days Non Expedited Average Days for Resolution Written Notice of Resolution within 30 CalendarDays Expedited Non Expedited Oral Written Oral Written 5 Working Days Written Notice Provided Final Disposition Moved to Non Expedited Oral Abandoned Final Disposition Upheld Overturned Partially Overturned Upheld Overturned Partially Overturned 02 Inpatient Hospital 12 Outpatient Hospital 03 Mental Hospital Provider Appeal Activity Provider Type/Category Beginning Balance Ending Balance Received Resolved Appeals Extended by 14 Calendar Days Total Oral Written 5 Working Days Written Notice Provided Total Resolved in 30 Calendar Days Average Days for Resolution Written Notice of Resolution within 30 Calendar Days Oral Abandoned Upheld Overturned Partially Overturned Inpatient Outpatient Unknown Type Date Format All report dates not otherwise specified are to be in the following format: mm/dd/yyyy COS Two character designation for a state specific category of service. Crosswalk may be found in Exhibit D. Category of Service (COS) Description A description for the ‘COS’. Medicaid Mandatory Services State covered Medicaid services required by federal law. Subtotal: Mandatory Services Calculated field. Sum total of all services listed as mandatory services For columns with Average Days it is the average days of resolution for all mandatory services. Medicaid Optional Services State covered Medicaid services in addition to the mandatory covered services the state has chosen to cover. Subtotal: Optional Services Calculated field. Sum total of all services listed as optional services. For columns with Average Days it is the average days of resolution for all optional services. Total: Mandatory and Optional Calculated field. Total of all mandatory and optional services. For columns with Average Days it is the average days of resolution for all mandatory and optional services. Provider Type/Category Crosswalk of Provider Type and Provider Specialty to each Provider Description listed is provided in Exhibit A: Provider Type and Specialty Crosswalk. Crosswalk of Provider Type Categories for General Hospital an...
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Pharmacy Behavioral Health Generic. An appeal submitted by a Provider on the Member’s behalf is to be reported under Member Appeal Activity. Member Appeal Activity COS Category of Service (COS) Description Beginning Balance Ending Balance Received Resolved Appeals Extended by 14 Calendar Days Total Expedi xxx Non Expedi xxx Total Expedited Resolved in 3 Working Days Non Expedited % Resolved in 30 Calendar Days Non Expedited Average Days for Resolution Written Notice of Resolution within 30 Calendar Expedited Non Expedited Oral Written Oral Written 5 Working Days Written Notice Final Disposition Moved to Non Expedited Oral Abandoned Final Disposition Upheld Overturned Partially Overturned Upheld Overturned Partially Overturned 02 Inpatient Hospital 12 Outpatient Hospital 03 Mental Hospital Provider Appeal Activity Provider Type/Category Beginning Balance Ending Balance Received Resolved Appeals Extended by 14 Calendar Days Total Oral Written 5 Working Days Written Notice d Total Resolved in 30 Calendar Days Average Days for Resolution Written Notice of Resolution h a n a a Oral Abandoned Upheld Overturned Partially Overturned Inpatient Outpatient Unknown Type d ei v o r P s Dy r
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Related to Pharmacy Behavioral Health Generic

  • Behavioral Health Services Behavioral health services include the evaluation, management, and treatment for a mental health or substance use disorder condition. For the purpose of this plan, substance use disorder does not include addiction to or abuse of tobacco and/or caffeine. Mental health or substance use disorders are those that are listed in the most updated volume of either: • the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association; or • the International Classification of Disease Manual (ICD) published by the World Health Organization. This plan provides parity in benefits for behavioral healthcare services. Please see Section 10 for additional information regarding behavioral healthcare parity. This plan covers behavioral health services if you are inpatient at a general or specialty hospital. See Inpatient Services in Section 3 for additional information. This plan covers services at behavioral health residential treatment facilities, which provide: • clinical treatment; • medication evaluation management; and • 24-hour on site availability of health professional staff, as required by licensing regulations. This plan covers intermediate care services, which are facility-based programs that are: • more intensive than traditional outpatient services; • less intensive than 24-hour inpatient hospital or residential treatment facility services; and • used as a step down from a higher level of care; or • used a step-up from standard care level of care. Intermediate care services include the following: • Partial Hospital Program (PHP) – PHPs are structured and medically supervised day, evening, or nighttime treatment programs providing individualized treatment plans. A PHP typically runs for five hours a day, five days per week. • Intensive Outpatient Program (IOP) – An IOP provides substantial clinical support for patients who are either in transition from a higher level of care or at risk for admission to a higher level of care. An IOP typically runs for three hours per day, three days per week.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (000) 000-0000. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Pharmacy Pharmacy hereby represents that neither Pharmacy, nor, to the best of Pharmacy’s knowledge, Pharmacist, Pharmacy’s employees, agents or independent

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • Mental Health Services This agreement covers medically necessary services for the treatment of mental health disorders in a general or specialty hospital or outpatient facilities that are: • reviewed and approved by us; and • licensed under the laws of the State of Rhode Island or by the state in which the facility is located as a general or specialty hospital or outpatient facility. We review network and non-network programs, hospitals and inpatient facilities, and the specific services provided to decide whether a preauthorization, hospital or inpatient facility, or specific services rendered meets our program requirements, content and criteria. If our program content and criteria are not met, the services are not covered under this agreement. Our program content and criteria are defined below.

  • Digital Health The HSP agrees to: (a) assist the LHIN to implement provincial Digital Health priorities for 2017-18 and thereafter in accordance with the Accountability Agreement, as may be amended or replaced from time to time; (b) comply with any technical and information management standards, including those related to data, architecture, technology, privacy and security set for health service providers by MOHLTC or the LHIN within the timeframes set by MOHLTC or the LHIN as the case may be; (c) implement and use the approved provincial Digital Health solutions identified in the LHIN Digital Health plan; (d) implement technology solutions that are compatible or interoperable with the provincial blueprint and with the LHIN Cluster Digital Health plan; and (e) include in its annual Planning Submissions, plans for achieving Digital Health priority initiatives.

  • Supplier Diversity Seller shall comply with Xxxxx’s Supplier Diversity Program in accordance with Appendix V.

  • Extended Health Care Plan ‌ The Employer shall pay the monthly premium for regular employees entitled to coverage under a mutually acceptable extended health care plan.

  • Mental Health The parties recognize the importance of supporting and promoting a psychologically healthy workplace and as such will adhere to all applicable statutes, policy, guidelines and regulations pertaining to the promotion of mental health.

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