PROVIDER REQUIREMENTS. The State Program, through contractual requirements and federal and State statutes and regulations, requires the Agreement to contain certain conditions that United and Provider agree to undertake, which include the following:
3.1 Definitions Related to the Provision of Covered Services. Provider shall follow the applicable State Contract’s requirements for the provision of Covered Services. Provider’s decisions affecting the delivery of acute or chronic care services to Covered Persons shall be made on an individualized basis and in accordance with the following definitions:
PROVIDER REQUIREMENTS. The State Program, through contractual requirements and federal and State statutes and regulations, requires the Agreement to contain certain conditions that Health Plan, Subcontractor and Provider agree to undertake, which include the following:
PROVIDER REQUIREMENTS. 2.6.7.5.1 Providers or collection agencies acting on the provider’s behalf may not xxxx enrollees for amounts other than applicable TennCare cost sharing or patient liability amounts for covered services, including but not limited to, services that the State or the CONTRACTOR has not paid for, except as permitted by TennCare rules and regulations and as described below. Providers may seek payment from an enrollee only in the following situations.
2.6.7.5.1.1 If the services are not covered services and, prior to providing the services, the provider informed the enrollee that the services were not covered. The provider shall inform the enrollee of the non-covered service and have the enrollee acknowledge the information. If the enrollee still requests the service, the provider shall obtain such acknowledgment in writing prior to rendering the service. Regardless of any understanding worked out between the provider and the enrollee about private payment, once the provider bills an MCO for the service that has been provided, the prior arrangement with the enrollee becomes null and void without regard to any prior arrangement worked out with the enrollee.
2.6.7.5.1.2 If the enrollee’s TennCare eligibility is pending at the time services are provided and if the provider informs the person they will not accept TennCare assignment whether or not eligibility is established retroactively. Regardless of any understanding worked out between the provider and the enrollee about private payment, once the provider bills an MCO for the service the prior arrangement with the enrollee becomes null and void without regard to any prior arrangement worked out with the enrollee.
2.6.7.5.1.3 If the enrollee’s TennCare eligibility is pending at the time services are provided, however, all monies collected, except applicable TennCare cost sharing or patient liability amounts shall be refunded when a claim is submitted to an MCO because the provider agreed to accept TennCare assignment once retroactive TennCare eligibility was established. (The monies collected shall be refunded as soon as a claim is submitted and shall not be held conditionally upon payment of the claim.)
2.6.7.5.1.4 If the services are not covered because they are in excess of an enrollee’s benefit limit, and the provider complies with applicable TennCare rules and regulations.
2.6.7.5.2 The CONTRACTOR shall require, as a condition of payment, that the provider accept the amount paid by the CONTRACTOR or appropri...
PROVIDER REQUIREMENTS. Pursuant to the State Contract and notwithstanding any other provision of this Appendix or the Agreement, Provider agrees to be bound by the provisions contained in the most current, per State Program, Arizona Minimum Subcontract Provisions located on the AHCCCS website at xxxx://xxx.xxxxxxxx.xxx. The Arizona Minimum Subcontract Provisions are incorporated into the Agreement. The State Program, through contractual requirements and federal and State statutes and regulations, requires the Agreement to contain certain conditions that United and Provider agree to undertake, which include the following:
3.1 Definitions Related to the Provision of Covered Services. Provider shall follow the applicable State Contract’s requirements for the provision of Covered Services. Provider’s decisions affecting the delivery of acute or chronic care services to Covered Persons shall be made on an individualized basis and in accordance with the following definitions:
PROVIDER REQUIREMENTS. The MississippiCAN Program, through the State Contract and federal and State statutes and regulations, requires the Agreement to contain certain conditions that Health Plan, Subcontractor and Provider agree to undertake, which include the following:
3.1 Definitions Related to the Provision of Covered Services. Provider shall follow the applicable State Contract’s requirements for the provision of Covered Services. Provider’s decisions affecting the delivery of acute or chronic care services to Covered Persons shall be made on an individualized basis and in accordance with the following definitions:
(a) Emergency Medical Condition: A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following: (1) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to body functions; or (3) serious dysfunction of any body organ or part.
PROVIDER REQUIREMENTS. A. In general:
1. A Provider, defined as “a licensed child development center or a licensed family child care home or expanded home” (5A District of Columbia Municipal Regulations (DCMR) § 299), that provides child care services for infants, toddlers or children ages birth to five, shall comply with all requirements of this section.
B. General and Reporting Requirements
PROVIDER REQUIREMENTS. Pursuant to the State Contract and notwithstanding any other provision of this Appendix or the Agreement, Provider agrees to be bound by the provisions contained in the most current, per State Program, Arizona Minimum Subcontract Provisions located on the AHCCCS website at xxxx://xxx.xxxxxxxx.xxx. The Arizona Minimum Subcontract Provisions are incorporated into the Agreement. The State Program, through contractual requirements and federal and State statutes and regulations, requires the Agreement to contain certain conditions that Health Plan, Subcontractor, and Provider agree to undertake, which include the following:
PROVIDER REQUIREMENTS. The State Program, through contractual requirements and federal and State statutes and regulations, requires the Agreement to contain certain conditions that Health Plan, Subcontractor and Provider agree to undertake, which include the following:
3.1 Definitions Related to the Provision of Covered Services. Provider shall follow the applicable State Contract’s requirements for the provision of Covered Services. Provider’s decisions affecting the delivery of acute or chronic care services to Customers shall be made on an individualized basis and in accordance with the following definitions:
i) Emergency Medical Condition: A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in any of the following: (1) placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (2) serious impairment to body functions; (3) serious dysfunction of any body organ or part; or (4) death.
PROVIDER REQUIREMENTS. Provider agrees:
a. It will comply with all obligations set forth in the Agreement and the DPA, including this Addendum;
b. It will provide the same or better level of privacy protections for RSA Data, and will not use or disclose any RSA Data in violation of the Agreement, the DPA, or any applicable US Privacy Laws;
c. It will maintain all permissions, authorizations, and consents required by the Agreement, the DPA, and any applicable US Privacy Laws;
d. It will promptly and without undue delay, notify RSA if it becomes aware of any violation of this Addendum or determines it can no longer fulfill its obligations under this Addendum or any applicable US Privacy Law, and in any event within five (5) business days of become aware or making such a determination;
e. If it engages a Subprocessor to perform any of its processing obligations under the Agreement, then Provider shall conduct a security and privacy compliance assessment of the Subprocessor to ensure the Subprocessor will meet the Personal Data protection and security requirements under the Agreement, the DPA, and applicable US Privacy Laws, inform RSA of the name of the Subprocessor, the location of the Subprocessor’s processing activities, and the nature of the processing and categories of Personal Data to be processed by the Subprocessor.
f. It shall maintain a privacy program and related policies that address how Personal Data is collected, used, shared, and otherwise processed, and ensure each person acting for or on behalf of Provider that is processing Personal Data is subject to a duty of confidentiality.
PROVIDER REQUIREMENTS. The State Programs, through contractual requirements and federal and State statutes and regulations, require the Agreement to contain certain requirements with which Health Plan and Subcontractor must comply, including the following:
3.1 Provider shall follow the State Contracts’ provisions for the coverage of Covered Services. Provider’s decisions affecting the delivery of acute or chronic care services to Covered Persons shall be made on an individualized basis and in accordance with the following definitions:
(a) Emergency Medical Condition: A medical or behavioral condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including severe pain, such that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in any of the following: (1) placing the health of the person afflicted with such condition in serious jeopardy, or in the case of a pregnant woman, the health of the woman or her unborn child or, in the case of a behavioral condition, placing the health of the person or others in serious jeopardy; (2) serious impairment to such person’s bodily functions; (3) serious dysfunction of any bodily organ or part of such person; or (4) serious disfigurement of such person.
