Provider Handbooks Sample Clauses

Provider Handbooks. 4.9.2.1 The Contractor shall issue a Provider Handbook to all network Providers at the time the Provider Contract is signed. The Contractor may choose not to distribute the Provider Handbook via mail, provided it submits a written notification to all Providers that explains how to obtain the Provider Handbook from the CMO’s Web site. This notification shall also detail how the Provider can request a hard copy from the CMO at no charge to the Provider. All Provider Handbooks and bulletins shall be in compliance with State and federal laws. The Provider Handbook shall serve as a source of information regarding GF Covered Services, policies and procedures, statutes, regulations, telephone access and special requirements to ensure all Contract requirements are being met. At a minimum, the Provider Handbook shall include the following information: · Description of the GF; · Covered Services; · Emergency Service responsibilities; · Health Check/EPSDT program services and standards; · Policies and procedures of the Provider complaint system; · Information on the Member Grievance System, including the Member’s right to a State Administrative Law Hearing, the timeframes and requirements, the availability of assistance in filing, the toll-free numbers and the Member’s right to request continuation of Benefits while utilizing the Grievance System; · Medical Necessity standards and practice guidelines; · Practice protocols, including guidelines pertaining to the treatment of chronic and complex Conditions; · PCP responsibilities; · Other Provider or Subcontractor responsibilities; · Prior Authorization, Pre-Certification, and Referral procedures; · Protocol for Encounter Data element reporting/records; · Medical Records standard; · Claims submission protocols and standards, including instructions and all information necessary for a clean or complete Claim; · Payment policies; · The Contractor’s Cultural Competency Plan; and · Member rights and responsibilities. 4.9.2.2 The Contractor shall disseminate bulletins as needed to incorporate any needed changes to the Provider Handbook. 4.9.2.3 The Contractor shall submit the Provider Handbook to DCH for review and approval and as updated. Any updates or revisions shall be submitted to DCH for review and approval at least 30 days prior to distribution.
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Provider Handbooks. 4.9.2.1 The Contractor shall issue a Provider Handbook to all network Providers at the time the Provider Contract is signed. The Contractor may choose not to distribute the Provider Handbook via mail, provided it submits a written notification to all Providers that explains how to obtain the Provider Handbook from the CMO’s Web site. This notification shall also detail how the Provider can request a hard-copy from the CMO at no charge to the Provider. All Provider Handbooks and bulletins shall be in compliance with State and federal laws. The Provider Handbook shall serve as a source of information regarding GHF Covered Services, policies and procedures, statutes, regulations, telephone access and special requirements to ensure all Contract requirements are being met. At a minimum the Provider Handbook shall include the following information: 4.9.2.1.1 Description of the GHF; 4.9.2.1.2 Covered Services; 4.9.2.1.3 Emergency Service responsibilities; 4.9.2.1.4 Health Check/EPSDT program services and standards; 4.9.2.1.5 Policies and procedures of the Provider complaint system; 4.9.2.1.6 Information on the Member Grievance System, including the Member’s right to a State Administrative Law Hearing, the timeframes and requirements, the availability of assistance in filing, the toll-free numbers and the Member’s right to request continuation of Benefits while utilizing the Grievance System; 4.9.2.1.7 Medical Necessity standards and practice guidelines; 4.9.2.1.8 Practice protocols, including guidelines pertaining to the treatment of chronic and complex Conditions;
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Provider Handbooks. The Health Plan shall develop and issue a Provider Handbook to all Providers at the time the Provider Contract is signed. The Health Plan may choose not to distribute the Provider Handbook via Surface Mail, provided it submits a written notification to all Providers that explains how to obtain the Provider Handbook from the Health Plan’s website. This notification shall also detail how the Provider can request a hard-copy from the Health Plan at no charge to the Provider. All Provider Handbooks and bulletins shall be in compliance with State and federal laws. The Provider Handbook shall serve as a source of information regarding Health Plan Covered Services, policies and procedures, statutes, regulations, telephone access and special requirements to ensure all Contract requirements are met. At a minimum, the Provider Handbook shall include the following information:
Sample 1Sample 2See All (4)
Provider Handbooks. 4.9.2.1 The Contractor shall issue a Provider Handbook to all network Providers at the time the Provider Contract is signed. The Contractor may choose not to distribute the Provider Handbook via mail, provided it submits a written notification to all Providers that explains how to obtain the Provider Handbook from the CMO’s Web site. This notification shall also detail how the Provider can request a hard copy from the CMO at no charge to the Provider. All Provider Handbooks and bulletins shall be in compliance with State and federal laws. The Provider Handbook shall serve as a source of information regarding GF Covered Services, policies and procedures, statutes, regulations, telephone access and special requirements to ensure all Contract requirements are being met. At a minimum, the Provider Handbook shall include the following information:
Sample 1

Related to Provider Handbooks

  • Member Handbook The Contractor shall develop a member handbook for its members. The Contractor’s member handbook shall be submitted annually for OMPP’s review. The member handbook shall include the Contractor’s contact information and Internet website address and describe the terms and nature of services offered by the Contractor, including the following information required under 42 CFR 438.10(f), which enumerates certain required information. The member handbook may be offered in an electronic format as long as the Contractor complies with 42 CFR 438.10(c)(6). The Hoosier Healthwise MCE Policies and Procedures Manual outlines the member handbook requirements. The Hoosier Healthwise member handbook shall include the following:  Contractor’s contact information (address, telephone number, TDD number, website address);  The amount, duration and scope of services and benefits available under the Contract in sufficient details to ensure that participants are informed of the services to which they are entitled, including, but not limited to the differences between the benefit options;  The procedures for obtaining benefits, including authorization requirements;  Contractor’s office hours and days, including the availability of a 24-hour Nurse Call Line;  Any restrictions on the member’s freedom of choice among network providers, as well as the extent to which members may obtain benefits, including family planning services, from out-of-network providers;  The extent to which, and how, after-hours and emergency coverage are provided, as well as other information required under 42 CFR 438.10(f), such as what constitutes an emergency;  The post-stabilization care services rules set forth in 42 CFR 422.113(c);  The extent to which, and how, urgent care services are provided;  Applicable policy on referrals for specialty care and other benefits not provided by the member’s PMP, if any;  Information about the availability of pharmacy services and how to access pharmacy services;  Member rights and protections, as enumerated in 42 CFR 438.100, which relates to enrollee rights. See Section 4.8 for further detail regarding member rights and protections;  Responsibilities of members;  Special benefit provisions (for example, co-payments, deductibles, limits or rejections of claims) that may apply to services obtained outside the Contractor’s network;  Procedures for obtaining out-of-network services;  Standards and expectations to receive preventive health services;  Policy on referrals to specialty care;  Procedures for notifying members affected by termination or change in any benefits, services or service delivery sites;  Procedures for appealing decisions adversely affecting members’ coverage, benefits or relationship with the Contractor;  Procedures for changing PMPs;  Standards and procedures for changing MCEs, and circumstances under which this is possible, including, but not limited to providing contact information and instructions for how to contact the enrollment broker to transfer MCEs due to one of the “for cause” reasons described in 42 CFR 438.56(d)(2)(iv), including, but not limited to, the following:  Receiving poor quality of care;  Failure to provide covered services;  Failure of the Contractor to comply with established standards of medical care administration;  Lack of access to providers experienced in dealing with the member’s health care needs;  Significant language or cultural barriers;  Corrective action levied against the Contractor by the office;  Limited access to a primary care clinic or other health services within reasonable proximity to a member’s residence;  A determination that another MCE’s formulary is more consistent with a new member’s existing health care needs;  Lack of access to medically necessary services covered under the Contractor’s contract with the State;  A service is not covered by the Contractor for moral or religious objections, as described in Section 6.3.3;  Related services are required to be performed at the same time and not all related services are available within the Contractor’s network, and the member’s provider determines that receiving the services separately will subject the member to unnecessary risk;  The member’s primary healthcare provider disenrolls from the member’s current MCE and reenrolls with another MCE; or  Other circumstances determined by the office or its designee to constitute poor quality of health care coverage.  The process for submitting disenrollment requests. This information shall include the following:  Hoosier Healthwise members may change MCEs after the first ninety (90) calendar days of enrollment only for cause;  Members are required to exhaust the MCE’s internal grievance and appeals process before requesting an MCE change ;  Members may submit requests to change MCEs to the Enrollment Broker verbally or in writing, after exhausting the MCE’s internal grievance and appeals process; and  The MCE shall provide the Enrollment Broker’s contact information and explain that the member must contact the Enrollment Broker with questions about the process. This information shall include how to obtain the Enrollment Broker’s standardized form for requesting an MCE change.  The process by which an American Indian/ Alaska Native member may elect to opt-out of managed care pursuant to 42 USC § 1396u–2(a)(2)(C) and transfer to fee-for-service benefits through the State;  Procedures for making complaints and recommending changes in policies and services;  Grievance, appeal and fair hearing procedures as required at 42 CFR 438.10(g)(2)(xi), including the following:  The right to file grievances and appeals;  The requirements and timeframes for filing a grievance or appeal;  The availability of assistance in the filing process;  The toll-free numbers that the member can use to file a grievance or appeal by phone;  The fact that, if requested by the member and under certain circumstances: (1) benefits will continue if the member files an appeal or requests a State fair hearing within the specified timeframes; and (2) the member may be required to pay the cost of services furnished during the appeal if the final decision is adverse to the member.  For a State hearing describe (i) the right to a hearing, (ii) the method for obtaining a hearing, and (iii) the rules that govern representation at the hearing.  Information about advance directives;  How to report a change in income, change in family size, etc.;  Information about the availability of the prior claims payment program for certain members and how to access the program administrator;  Information on alternative methods or formats of communication for visually and hearing-impaired and non-English speaking members and how members can access those methods or formats;  Information on how to contact the Enrollment Broker;  Statement that Contractor will provide information on the structure and operation of the health plan; and  In accordance with 42 CFR 438.10(f)(3), that upon request of the member, information on the Contractor’s provider incentive plans will be provided.

  • Privacy Policies Each party will make available a Privacy Policy that complies with Law. Xxxxxx’s Privacy Policy explains how and for what purposes Stripe collects, uses, retains, discloses and safeguards the Personal Data you provide to Stripe.

  • Policies and Procedures i) The policies and procedures of the designated employer apply to the employee while working at both sites. ii) Only the designated employer shall have exclusive authority over the employee in regard to discipline, reporting to the College of Nurses of Ontario and/or investigations of family/resident complaints. iii) The designated employer will ensure that the employee is covered by WSIB at all times, regardless of worksite, while in the employ of either home. iv) The designated employer will ensure that the employee is covered by liability insurance at all times, regardless of worksite, while in the employ of either home. v) The designated employer shall have exclusive authority over the employee’s personnel files and health records. These files will be maintained on the site of the designated employer.

  • Company Policies and Procedures 7.1.1 The Company will ensure that Employees are able to readily access Company policies and procedures that apply to the Employees. 7.1.2 The Employees will observe and act in accordance with Company policies and procedures that apply to the Employees, as implemented and amended from time to time.

  • Personnel Policies The School shall adopt, update, and adhere to personnel policies. These policies must be made readily accessible from the School’s website or school office, as described in Section 11.4. 1. If the policy is not available from the School’s website, the School shall submit the current policy to the Commission.

  • PROCUREMENT ETHICS Contractor understands that a person who is interested in any way in the sale of any supplies, services, construction, or insurance to the State of Utah is violating the law if the person gives or offers to give any compensation, gratuity, contribution, loan, reward, or any promise thereof to any person acting as a procurement officer on behalf of the State of Utah, or who in any official capacity participates in the procurement of such supplies, services, construction, or insurance, whether it is given for their own use or for the use or benefit of any other person or organization.

  • Manuals Each product delivered under contract to any Customer must be delivered with at least one (1) copy of a safety and operating manual and any other technical or maintenance manual. The cost of the manual(s) must be included in the price for the Product offered.

  • Contractor Certification Regarding Ethics The Contractor certifies that the Contractor is now, and shall remain, in compliance with Chapter 42.52 RCW, Ethics in Public Service, throughout the term of this Contract.

  • Provider Network The Panel of health service Providers with which the Contractor contracts for the provision of covered services to Members and Out-of-network Providers administering services to Members.

  • Operations Manual The Franchisor agrees to loan to the Franchisee one or more manuals, technical bulletins, cookbooks and recipes and other written materials (collectively referred to as “Operations Manual”) covering Factory Candy ordering, Store Candy manufacturing, processing and stocking and other operating and in-store marketing techniques for the ROCKY MOUNTAIN CHOCOLATE FACTORY Store. The Franchisee agrees that it shall comply with the Operations Manual as an essential aspect of its obligations under this Agreement, that the Operations Manual shall be deemed to be incorporated herein by reference and failure by the Franchisee to substantially comply with the Operations Manual may be considered by the Franchisor to be a breach of this Agreement.

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