Primary Care to Specialist eReferral eReferral fee codes will be established for dermatology and ophthalmology, with subsequent expansion to other specialties.
Primary Care to Specialist eReferral Sample Clauses
Related to Primary Care to Specialist eReferral
CHILD AND DEPENDENT ADULT/ELDER ABUSE REPORTING CONTRACTOR shall establish a procedure acceptable to ADMINISTRATOR to ensure that all employees, agents, subcontractors, and all other individuals performing services under this Agreement report child abuse or neglect to one of the agencies specified in Penal Code Section 11165.9 and dependent adult or elder abuse as defined in Section 15610.07 of the WIC to one of the agencies specified in WIC Section 15630. CONTRACTOR shall require such employees, agents, subcontractors, and all other individuals performing services under this Agreement to sign a statement acknowledging the child abuse reporting requirements set forth in Sections 11166 and 11166.05 of the Penal Code and the dependent adult and elder abuse reporting requirements, as set forth in Section 15630 of the WIC, and shall comply with the provisions of these code sections, as they now exist or as they may hereafter be amended.
Evaluation, Testing, and Monitoring 1. The System Agency may review, test, evaluate and monitor Grantee’s Products and services, as well as associated documentation and technical support for compliance with the Accessibility Standards. Review, testing, evaluation and monitoring may be conducted before and after the award of a contract. Testing and monitoring may include user acceptance testing. Neither the review, testing (including acceptance testing), evaluation or monitoring of any Product or service, nor the absence of review, testing, evaluation or monitoring, will result in a waiver of the State’s right to contest the Grantee’s assertion of compliance with the Accessibility Standards.
CHILD ABUSE REPORTING CONTRACTOR hereby agrees to annually train all staff members, including volunteers, so that they are familiar with and agree to adhere to its own child and dependent adult abuse reporting obligations and procedures as specified in California Penal Code section 11165.7, AB 1432, and Education Code 44691. To protect the privacy rights of all parties involved (i.e., reporter, child and alleged abuser), reports will remain confidential as required by law and professional ethical mandates. A written statement acknowledging the legal requirements of such reporting and verification of staff adherence to such reporting shall be submitted to the LEA.
Drug and Alcohol Testing – Safety-Sensitive Functions A. Employees required to have a Commercial Driver’s License (CDL) are subject to pre-employment, post-accident, random and reasonable suspicion testing in accordance with the U.S. Department of Transportation rules, Coast Guard Regulations (46 CFR Part 16) or the Federal Omnibus Transportation Employee Testing Act of 1991. The testing will be conducted in accordance with current Employer policy.
Primary Care Clinic Employees and each of their covered dependents must individually elect a primary care clinic within the network of providers offered by the plan administrator chosen by the employee. Employees and their dependents may elect to change clinics within their clinic’s Benefit Level as often as the plan administrator permits and as outlined above.
Pupil Safety and Fingerprinting CONTRACTOR shall comply with all provisions of the Education Code which protect the safety of any pupil that may come in contact with employees of the CONTRACTOR. Pursuant to Education Code section 45125.1, CONTRACTOR shall conduct criminal background checks of ALL employees of CONTRACTOR assigned to the PROJECT site, and shall certify that no employees who have been convicted of serious or violent felonies, as specified in Education Code Section 45125.1, will have contact with pupils, by utilizing the General Certification Regarding Background Checks Form. As part of such certification, CONTRACTOR must provide the District with a list of all employees providing services pursuant to this Agreement, and designate which sites such employees will be assigned. In performing the services set forth in this Agreement, CONTRACTOR shall not utilize any employees who are not included on the above-referenced list. At District’s sole discretion, District may make a finding, as authorized under Education Code section 45125.1, that CONTRACTOR’s employees will have only “limited contact” with pupils. In accordance with Education Code Section 45125.2, a CONTRACTOR performing construction, reconstruction, rehabilitation or repair services to a school facility shall not be required to perform Section 45125.1 background checks of all employees assigned to the PROJECT site if such CONTRACTOR installs a physical barrier at the worksite to limit employee contact with pupils and/or provides continual supervision and monitoring of all employees of the CONTRACTOR by an employee of the CONTRACTOR whom the Department of Justice has ascertained has not been convicted of a violent or serious felony. Such CONTRACTOR shall certify to the District its compliance with one of the aforementioned alternatives under Education Code Section 45125.2 pertaining to pupil safety with the form entitled CONSTRUCTION CONTRACTOR CERTIFICATION REGARDING BACKGROUND CHECKS which is on file at the Administrative Office of the DISTRICT. Contractor’s failure to comply with the law or Article VI, Paragraph 4 of this Agreement shall be considered a material breach of this Agreement upon where this Agreement may be terminated, at District’s sole discretion, without any further compensation to Contractor.
SPECIALIST SERVICES Medical care in specialties other than family practice, general practice, internal medicine [or pediatrics][or obstetrics/gynecology (for routine pre and post-natal care, birth and treatment of the diseases and hygiene of females)].
Outpatient Dental Anesthesia Services This plan covers anesthesia services received in connection with a dental service when provided in a hospital or freestanding ambulatory surgical center and: • the use of this is medically necessary; and • the setting in which the service is received is determined to be appropriate. This plan also covers facility fees associated with these services.
Emergency and urgently needed care outside the service area Professional services of a physician, emergency room treatment, and inpatient hospital services are covered at eighty percent (80%) of the first two thousand dollars ($2,000) of the charges incurred per insurance year, and one-hundred percent (100%) thereafter. The maximum eligible out-of-pocket expense per individual per year for this benefit is four hundred dollars ($400). This benefit is not available when the member’s condition permits him or her to receive care within the network of the plan in which the individual is enrolled.
Tobacco Use Counseling and Intervention This plan covers smoking cessation programs when prescribed by a physician in accordance with R.I. General Law §27-20-53 and ACA guidelines. Smoking cessation programs include, but are not limited to, the following: • Smoking cessation counseling must be provided by a physician or upon his or her referral to a qualified licensed practitioner. • Over-the-counter and FDA approved nicotine replacement therapy and/or smoking cessation prescription drugs, prescribed by a physician, and purchased at a pharmacy. See the Summary of Pharmacy Benefits for details on coverage. Vaccinations/Immunizations This plan covers adult and pediatric preventive vaccinations and immunizations in accordance with current guidelines. Our allowance includes the administration and the vaccine. If a covered immunization is provided as part of an office visit, the office visit copayment and deductible (if any) will apply. Travel immunizations are covered to the extent that such immunizations are recommended for adults and children by the Centers for Disease Control and Prevention (CDC). The recommendations are subject to change by the CDC. Preventive Screening/Early Detection Services This plan covers preventive screenings based on the ACA guidelines noted above. Preventive screenings include but are not limited to: • mammograms; • pap smears; • prostate-specific antigen (PSA) tests; • flexible sigmoidoscopy; • double contrast barium enema; • fecal occult blood tests, screening for gestational diabetes, and human papillomavirus; and • genetic counseling for breast cancer susceptibility gene (BRCA). This plan covers colonoscopies in accordance with R.I. General Laws § 27-18-58. Covered healthcare services include an initial colonoscopy or other medical tests or procedures for colorectal cancer screening and a follow-up colonoscopy if the results of the initial test are abnormal. Contraceptive Methods and Sterilization Procedures for Women This plan covers the following contraceptive services: • FDA approved contraceptive drugs and devices requiring a prescription; • barrier method (cervical cap, diaphragm, or implantable) fitted and supplied during an office visit; and • surgical and sterilization services for women with reproductive capacity, including but not limited to tubal ligation. Breastfeeding Counseling and Equipment This plan covers lactation (breastfeeding) support and counseling during the pregnancy or postpartum period when provided by a licensed lactation counselor. This plan covers manual, electric, or battery operated breast pumps for a female member in conjunction with each birth event.
