Plan or Plan Sample Clauses

Plan or Plan the prepaid health care plan developed by the contractor in performance of its duties and responsibilities under this contract; or a contractual arrangement between the Agency and a comprehensive health care contractor for the provision of Medicaid care, goods, or services on a prepaid basis to Medicaid recipients. Primary Care Physician - a Medicaid-participating or prepaid health plan-affiliated physician practicing as a general or family practitioner, internist, pediatrician, obstetrician, gynecologist, or other specialty approved by the Agency, who furnishes primary care and patient management services to an enrollee. Prior Authorization - the act of authorizing specific services before they are rendered. Project - Long Term Care Community Diversion Program. Protocols - written guidelines or documentation outlining steps to be followed for handling a Amendment 001 Agreement Number XQ744 particular situation, resolving a problem, or implementing a plan of medical, social, nursing, psycho social, developmental and educational services. Provider - a person or entity who is responsible for or directly provides any medical or social services authorized by this contract. Provider Handbook - a document that provides information to a Medicaid provider regarding enrollee eligibility, claims submission and processing, provider participation, covered care, goods, or services and limitations, procedure codes and fees, and other matters related to Medicaid program participation. Quality Assurance - the process of assuring that the delivery of health care is appropriate, timely, accessible, available, and medically necessary.