Provider Availability. Provider agrees that it will accept new Enrollees for as long as it is accepting new patients enrolled in government sponsored programs subject to the scope of Provider's licensure or certification and any applicable Mandates and regulatory requirements including but not limited to provider-to-patient ratios. Provider shall provide at least sixty (60) days prior written notice to ILS Community Network if it or any of its locations are no longer available to prospective Enrollees.
Provider Availability. Provider shall ensure that Covered Services, when necessary, or when Practice Provider is otherwise absent, are available twenty-four (24) hours a day, seven (7) days a week.
Provider Availability. All providers owned (wholly or partially) or controlled by the CONTRACTOR, or any of the CONTRACTOR'S related or affiliated entities, and any and all providers that own (wholly or partially) or control the CONTRACTOR, shall be willing to become a network provider for any managed care organization that contracts with HSD for Medicaid managed care services, to be reimbursed by such MCO at the then-current and applicable Medicaid reimbursement rate for that provider type. The Applicable Medicaid reimbursement rate is defined to exclude disproportionate share and medical education payments.
Provider Availability. PROVIDER shall provide the SERVICES on a daily 24- hour basis during the term of this Agreement.
Provider Availability. 8.2.1 List all occurrences where CONTRACTOR was unable to locate providers with vacancies and include reason such as no infant provider in the required area.
Provider Availability. 1. The Contractor must provide a 24-hours-per-day, 7-days-per-week toll- free system with access to a registered nurse who:
a. Has immediate access to the Centralized Enrollee Record (see Section 2.6.F);
b. Is able to respond to Enrollee questions about health or medical concerns;
c. Has the experience and knowledge to provide clinical triage;
d. Is able to provide options other than waiting until business hours or going to the emergency room; and
e. Is able to provide access to oral interpretation services available as needed, free-of-charge.
2. The Contractor must follow Federal and State regulations about 24-hour service availability (for example, hospital, home health, and hospice require 24-hour availability; adult day health, homemaker, and chore services do not).
3. The Contractor’s provider network must ensure access to 24-hour Emergency Services for all Enrollees, whether they reside in institutions or in the community. The Contractor must:
a. Have a process established to notify the PCP or ICT (or the designated covering physician) of an Emergency Condition within one business day after the Contractor is notified by the provider. If the Contractor is not notified by the provider within 10 calendar days of the Enrollee’s presentation for Emergency Services, the Contractor may not refuse to cover Emergency Services.
b. Have a process to notify the PCP or ICT of required Urgent Care within 24 hours of the Contractor being notified.
c. Record summary information about Emergency Conditions and Urgent Care services in the Centralized Enrollee Record no more than 18 hours after the PCP or ICT is notified, and a full report of the services provided within two business days.
d. Pay the provider or reimburse the Enrollee, in the fee-for-service amount that would have been paid by Medicare or MassHealth, if services are obtained out of network for Emergency Conditions. This must be done within 60 calendar days after the claim has been submitted. The Contractor must ensure that cost to the Enrollee is no greater than it would be if the services were furnished within the network.
e. Cover and pay for any services obtained for Emergency Conditions in accordance with 42 C.F.R. 438.114(c). The Contractor may not deny payment for treatment obtained when an enrollee had an Emergency Condition, including cases in which the absence of immediate medical attention would not have had the outcomes specified in 42 C.F.R 438.114(a) of the definition of emergency medical c...
Provider Availability. All providers owned (wholly or partially) or controlled by the CONTRACTOR, or any of the CONTRACTOR’S related or affiliated entities, and any and all providers that own (wholly or partially) or control the CONTRACTOR, to the extent of its legal authority, shall be willing to become a network provider for any CONTRACTOR that contracts with HSD/MAD for Medicaid care services, to be reimbursed by such CONTRACTOR at the then-current and applicable Medicaid reimbursement rate for that provider type. The applicable Medicaid reimbursement rate is defined to exclude disproportionate share and medical education payments.
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35.1 All providers owned (wholly or partially) or controlled by the CONTRACTOR, or any of the CONTRACTOR’S related or affiliated entities, and any and all providers that own (wholly or partially) or control the CONTRACTOR, to the extent of its legal authority, shall be willing to become a network provider for any Contractor that contracts with the State for Covered Services, to be reimbursed by such Contractor at the then-current and applicable Medicaid reimbursement rate for that provider type. The applicable Medicaid reimbursement rate is defined to exclude disproportionate share and medical education payments.
Provider Availability. The home day care provider must be available between the hours 7:00 am to 6:00pm Some parents work late hours, overnights, or weekends, and some work shifts. Home day care must be flexible. Extended hours fee will be paid to the providers after 12 hours of care. Please mark the hours you are available daily. MON _________ TUE _________ WED _______ THU ________ FRI__________
Provider Availability. We will make every effort to avail the services of our clinic to its members at the time of medical need. This includes after hours and weekend access to a Provider by phone for medical advice and treatment when appropriate. A Provider will endeavor to respond to urgent phone messages within one hour and to return non-urgent messages within one business day. It should be understood that We have regular office hours and that outside of these hours a Provider will not always be physically available for care. Medical care is provided by appointment only; “walk-in” care is not available.
