Provider Policy and Procedures Manual Sample Clauses

Provider Policy and Procedures Manual. The Contractor shall provide and maintain a Provider Policies and Procedures Manual for use by the Contractor’s network of Hoosier Healthwise providers. The Provider Policies and Procedures Manual shall be available both electronically and in hard copy (upon request) to all network providers, without cost, when they are initially enrolled, when there are any chances in policies and procedures, and upon a provider’s request. The Provider Policies and Procedures Manual shall include, at minimum, the following information, separately stated for each State lines of business as appropriate:  Benefits and limitations;  Claims filing instructions;  Criteria and process to use when requesting prior authorizations;  Definition and requirements pertaining to urgent and emergent care;  Participants’ rights;  Providers’ rights for advising or advocating on behalf of his or her patient;  Provider non-discrimination information;  Policies and procedures for grievances and appeals in accordance with 42 CFR 438.414;  Frequently asked questions and answers; and  Contractor, FSSA and OMPP contact information such as addresses and phone numbers. The Contractor shall offer Provider Policies and Procedures Manual training to all network providers when they are initially enrolled in the network, whenever there are changes in policies or procedures, and upon a provider’s request. Updates or changes in operation that require revisions to the Provider Policies and Procedures Manual shall be submitted to OMPP for review and approval in accordance with the requirements outlined in Section 5.7.1.
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Provider Policy and Procedures Manual. The Contractor shall provide and maintain a Provider Policies and Procedures Manual for ovider Policies and Procedures Manual shall be available both electronically and in hard copy (upon request) to all network providers, without cost, when they are initially enrolled, when there are any chances in policies and procedures, and upon a provide Policies and Procedures Manual shall include, at minimum, the following information, separately stated for each State lines of business as appropriate: Benefits and limitations; Claims filing instructions; Definition and requirements pertaining to urgent and emergent care; Provider non-discrimination information; Policies and procedures for grievances and appeals in accordance with 42 CFR 438.414; Frequently asked questions and answers; and Contractor, FSSA and OMPP contact information such as addresses and phone numbers. The Contractor shall offer Provider Policies and Procedures Manual training to all network providers when they are initially enrolled in the network, whenever there are operation that require revisions to the Provider Policies and Procedures Manual shall be submitted to OMPP for review and approval in accordance with the requirements outlined in Section 5.7.1.
Sample 1

Related to Provider Policy and Procedures Manual

  • Policy and Procedures If the resident leaves the facility due to hospitalization or a therapeutic leave, the facility shall not be obligated to hold the resident’s bed available until his or her return, unless prior arrangements have been made for a bed hold pursuant to the facility’s “Bed Reservation Policy and Procedure” and pursuant to applicable law. In the absence of a bed hold, the resident is not guaranteed readmission unless the resident is eligible for Medicaid and requires the services provided by the facility. However, the resident may be placed in any appropriate bed in a semi-private room in the facility at the time of his or her return from hospitalization or therapeutic leave provided a bed is available and the resident’s admission is appropriate and meets the readmission requirements of the facility.

  • 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.

  • Violence Policies and Procedures The Employer agrees to have in place explicit policies and procedures to deal with violence. The policy will address the prevention of violence, the management of violent situations, provision of legal counsel and support to employees who have faced violence. The policies and procedures shall be part of the employee's health and safety policy and written copies shall be provided to each employee. Prior to implementing any changes to these policies, the employer agrees to consult with the Association.

  • SPAM POLICY You are strictly prohibited from using the Website or any of the Company's Services for illegal spam activities, including gathering email addresses and personal information from others or sending any mass commercial emails.

  • COMPLIANCE WITH POLICIES AND PROCEDURES During the period that Executive is employed with the Company hereunder, Executive shall adhere to the policies and standards of professionalism set forth in the policies and procedures of the Company and IAC as they may exist 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.

  • Safety Policy The City agrees to maintain in safe working condition all facilities and equipment furnished by the City to carry out the duties of each bargaining unit position, but reserves the right to determine what those facilities and equipment shall be. The Association agrees to work cooperatively in maintaining safety in the Xenia/Xxxxxx Central Communications Center.

  • Compliance Policies and Procedures To assist the Fund in complying with Rule 38a-1 of the 1940 Act, BBH&Co. represents that it has adopted written policies and procedures reasonably designed to prevent violation of the federal securities laws in fulfilling its obligations under the Agreement and that it has in place a compliance program to monitor its compliance with those policies and procedures. BBH&Co will upon request provide the Fund with information about our compliance program as mutually agreed.

  • Policies and Practices The employment relationship between the Parties shall be governed by this Agreement and the policies and practices established by the Company and the Board of Directors (hereinafter referred to as the “Board”). In the event that the terms of this Agreement differ from or are in conflict with the Company’s policies or practices or the Company’s Employee Handbook, this Agreement shall control.

  • Summary of Policy and Prohibitions on Procurement Lobbying Pursuant to State Finance Law §139-j and §139-k, this Contract includes and imposes certain restrictions on communications between OGS and a Vendor during the procurement process. A Vendor is restricted from making contacts from the earliest notice of intent to solicit offers/bids through final award and approval of the Procurement Contract by OGS and, if applicable, the Office of the State Comptroller (“restricted period”) to other than designated staff unless it is a contact that is included among certain statutory exceptions set forth in State Finance Law §139-j(3)(a). Designated staff, as of the date hereof, is identified in Appendix G, Contractor and OGS Information, or as otherwise indicated by OGS. OGS employees are also required to obtain certain information when contacted during the restricted period and make a determination of the responsibility of the Vendor pursuant to these two statutes. Certain findings of non-responsibility can result in rejection for contract award and in the event of two findings within a four-year period; the Vendor is debarred from obtaining governmental Procurement Contracts. Further information about these requirements can be found on the OGS website: xxxx://xxx.xxx.xx.xxx/aboutOgs/regulations/defaultSFL_139j-k.asp.

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