Common use of Preferred Provider Responsibility Clause in Contracts

Preferred Provider Responsibility. Preferred Providers located in the CareFirst service area are responsible for providing utilization management notices and obtaining necessary utilization management approvals on the Member’s behalf. However, the Member must advise the provider that coverage exists under the plan. In addition, the Member must comply with utilization management requirements and determinations. If the Preferred Provider fails to obtain such prior authorization, the Member will be held harmless.