Common use of Procedures, Communications and Other Administrative Duties Clause in Contracts

Procedures, Communications and Other Administrative Duties. 1. OhioHealthy shall require Payor to establish a system of Beneficiary identification and procedures for verification by Practitioner (through written or telephone request) of Beneficiary eligibility to receive Covered Services and whether certain services to be rendered to a Beneficiary are Covered Services, which system and procedures shall be communicated to Practitioner. Beneficiary identification cards and such other mechanisms or procedures instituted by OhioHealthy or a Payor do not guarantee eligibility and Beneficiary eligibility determinations are not a guarantee of participation or coverage or payment, both participation and coverage must be determined in accordance with the terms of applicable Program Requirements. 2. OhioHealthy shall from time to time communicate to Practitioner the current Program Requirements of the Programs in which Practitioner is participating, which shall include, without limitation, specific information regarding Covered Services and applicable Coinsurance, Copayments and Deductibles. 3. OhioHealthy shall provide Payors with information identifying Practitioner as a Participating Practitioner and explaining, with particularity, the availability of Health Care Services from Practitioner and the economic benefits of the use by Beneficiaries of Participating Practitioners and Providers. However, OhioHealthy cannot guarantee that any Payor will, in turn, provide such information to Beneficiaries. 4. OhioHealthy shall list the name, address, telephone number and specialty(ies) of Practitioner in a directory or listing of Participating Practitioners and Participating Providers which shall be kept reasonably updated and may be furnished to Payors and Beneficiaries from time to time. OhioHealthy may also list the name, address, telephone number and specialty(ies) of Practitioner in other materials or publications deemed by OhioHealthy, in its sole discretion, to be reasonably necessary or desirable for the conduct of OhioHealthy’s business. Practitioner authorizes OhioHealthy and other Payors to utilize the directory or listing information in any marketing activities undertaken by OhioHealthy or applicable Payors. Upon termination of this Agreement, Practitioner shall not engage in any activity that implies a continuing relationship with OhioHealthy or any of the Programs; and Practitioner acknowledges and agrees that to do so would cause OhioHealthy irreparable harm.