Prior Authorization and Referrals. PPG and Member Physicians agree to comply with prior authorization and referral processes as required by the particular Benefit Program or Utilization/Care Management Program as set forth in the Operations Manual. In the event PPG agrees to participate in a program offered by another health plan, preferred provider organization, managed care organization, or insurer which includes an expedited process for referrals or authorizations, PPG agrees to participate in and offer the same access for FHS Members for any such program offered by FHS. Prior authorizations or referrals may be issued by FHS, PPG, a Participating Provider, or Member Physician in accordance with the applicable Benefit Program. For non-emergent services, PPG or Participating Provider agrees to obtain prior authorization or a referral before providing or ordering Covered Services if required by the applicable Benefit Program. In an Emergency, PPG agrees to attempt to obtain prior authorization or a referral, by telephone if necessary, before providing or ordering Covered Services. If prior authorization or a referral cannot be obtained, PPG agrees to notify FHS and the appropriate Participating Provider, as soon as possible, but no later than twenty-four (24) hours after admission. In the even PPG fails to obtain an authorization or a referral, PPG agrees not to seek payment from FHS or a Payor for Contracted Services rendered to a Member unless prior authorization or a referral was obtained. FHS shall retain the right to authorize Emergency services in accordance with the Operations Manual.
Prior Authorization and Referrals. Unless a particular Benefit Program or Utilization/Care Management Program contains no such requirement, and except in an Emergency, PPG agrees not to seek payment from FHFS or a Payor for Covered Services rendered to a Member unless Prior Authorization or a Referral was obtained for the rendering of such services. Such Prior Authorization or Referral may be issued by FHFS, or the applicable Payor. If Prior Authorization or a Referral cannot be obtained, PPG agrees to notify FHFS or the applicable Payor and the appropriate Participating Provider, as applicable, as soon as possible, but no later than twenty-four (24) hours after providing the Covered Services, or ordering the other Covered Services, or on the next working day. (See TRICARE Network Provider Manual.)
Prior Authorization and Referrals. When either Prior Authorization and/or a Referral is required for the rendition of a Community Supports service, the receipt of the required Prior Authorization and/or the required Referral, each being separate and distinct requirements, is a prerequisite to payment of Complete Claims for Covered Services in addition to confirming eligibility prior to delivering service as required by this Agreement and Health Net Policies. Health Net (or its designee as applicable) may rescind or modify its Prior Authorization, in a manner consistent with Health Net Policies, based on variety of factors, including but not limited to the eligibility of the Beneficiary
Prior Authorization and Referrals. Unless a particular Benefit ---------------------------------- Program or Utilization Management Program contains no such requirement, and except in an Emergency, Provider agrees not to seek payment from Foundation or a Payor for Contracted Services rendered to a Beneficiary unless Prior Authorization or a Referral was obtained for the rendering of such services. Such Prior Authorization or Referral may be issued by Foundation, the applicable Payor, or a Participating Provider. In an Emergency, Provider agrees to attempt to obtain Prior Authorization, by telephone if necessary, before admitting a Beneficiary either as an inpatient or outpatient, or providing Contracted Services. If Prior Authorization or Referral cannot be obtained, Provider agrees to notify Foundation or the applicable Payor and the appropriate Participating Provider as applicable, as soon as possible, but no later than 24 hours after admission, or providing the Contracted Services, or on the next working day.
Prior Authorization and Referrals. Provider agrees to comply with any Prior Authorization and/or Referral requirements that are set forth in the Provider Manual.
Prior Authorization and Referrals. PROVIDER and Participating Providers agree to comply with prior authorization and referral processes as required by the particular Benefit Program or Utilization/Care Management Program as set forth in the Operations Manual. Prior authorization or referral may be issued by HNI, PROVIDER, or a Participating Provider. For non-emergent services, PROVIDER or Participating Provider agrees to obtain prior authorization or a referral before providing or ordering Contracted Services. In an Emergency, PROVIDER agrees to attempt to obtain prior authorization or a referral, by telephone if necessary, before providing or ordering Contracted Services. If prior authorization or a referral cannot be obtained in an Emergency, PROVIDER agrees to notify HNI and the appropriate Participating Provider, as soon as possible, but no later than twenty-four (24) hours after services are rendered. In the event PROVIDER fails to obtain an authorization or a referral, PROVIDER agrees not to seek payment from HNI or a Payor for Contracted Services rendered to a Member unless prior authorization or a referral was obtained. HNI shall retain the right to authorize Emergency services in accordance with the Operations Manual.
Prior Authorization and Referrals. Provider shall comply with the requirements in Plan Policies relating to prior authorization and referrals. Failure to comply with Plan’s prior authorization and referral requirements may result in denial of payment for services provided by Provider.
