Provide Referral Services Sample Clauses

Provide Referral Services. With the prior approval of PacifiCare (except in the case of Emergency Services), Medical Group shall arrange any necessary Referral Services to PacifiCare’s selection of Participating Providers for Medical Group Members (which shall be shown on the PacifiCare list of providers of Referral Services).
Sample 1
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Provide Referral Services. With the prior approval of PacifiCare (except in the case of Emergency Services), Medical Group shall arrange any necessary Referral Services to PacifiCare’s selection of Participating Providers for Medical Group Members, which shall be shown on the PacifiCare’s list of providers of Referral Services sent to the Medical Group on a monthly basis. Use of PacifiCare’s list of providers of Referral Services does not apply to Medically Necessary Services arranged by Medical Group that are not available through a provider on PacifiCare’s list of providers of Referral Services. Furthermore, PacifiCare may determine that such failure constitutes material breach in accordance with Section 6.2.3 of this Agreement.
Sample 1
Provide Referral Services. With the prior approval of PacifiCare (except in the case of Emergency Services), Medical Group shall arrange any necessary Referral Services to PacifiCare’s selection of Participating Providers for Medical Group Members, which shall be shown on the PacifiCare’s list of providers of Referral Services. Should Medical Group direct Referral Services for Members to providers other than those on PacifiCare’s list of providers of Referral Services and without PacifiCare’s prior approval, Medical Group understands and accepts that Medical Group may be responsible for any increased costs to PacifiCare for professional or facility services not provided in accordance with the foregoing, for amounts during a calendar year of up to twenty (20%) percent of the Medical Group’s total capitation payments from PacifiCare. If PacifiCare incurs increased costs for Covered Services as a result of the foregoing, PacifiCare will provide written notification to Medical Group of such occurrence and Medical Group agrees that PacifiCare may deduct the amount of such increased costs from any future Capitation Payments or amounts otherwise owed to Medical Group under this Agreement. Furthermore, PacifiCare may determine that such failure constitutes material breach of this Agreement. Medical Group may address any objection to PacifiCare’s determination of increased costs according to the Dispute Resolution Procedures described in this Agreement. Should Medical Group prevail in any Dispute Resolution Procedure, PacifiCare shall refund the amount of any overturned deduction to Medical Group within forty-five (45) days following the resolution of the dispute. Further, PacifiCare shall refund any deductions in excess of twenty percent (20%) of PacifiCare’s total capitation payments to Medical Group/Hospital in any single calendar year.
Sample 1

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