Common use of PROVIDER SERVICES AND RESPONSIBILITIES Clause in Contracts

PROVIDER SERVICES AND RESPONSIBILITIES. 4.1 The Provider agrees to provide quality health care in a cost efficient manner. 4.2 For the purpose of reimbursement, the Provider shall provide services to members that are medically necessary and covered under the Health Insurance Plan. 4.3 The Provider agrees to make reasonable effort to refer covered members to those Network Providers, with which EGID contracts, for medically necessary services that the Provider cannot or chooses not to provide. Failure of the Provider to use Network Providers will result in a review pursuant to the credentialing plan. 4.4 The Provider shall prescribe for EGID members medications identified on the adopted formulary or explain, in writing, on behalf of the member to EGID why it is medically inappropriate to do so. 4.5 The Provider shall participate in the preadmission certification, concurrent review, and prior authorization procedures provided in Article VII and for purposes of reimbursement to abide by decisions resulting from those reviews subject to rights of reconsideration, review and appeal. 4.6 The provider shall submit a current, complete and accurate Oklahoma Uniform Credentialing Application (ODH From 606) and EGID OUCA Supplement as allowed under OK §63-1-106.2 and Laws 1998, c. 210, § 1 which are incorporated herein by reference. The provider shall notify EGID’s Network Management of any change in the information contained in the Application within 15 days of such change. 4.7 The Provider shall reimburse EGID for any overpayments made to the Provider within 30 days of the Provider's receipt of the overpayment notification. 4.8 The Provider shall submit to a patient record audit upon 48 hours advance notice. 4.9 The Provider shall participate in HELP/Wellness promotions sponsored by the EGID, at EGID’s allowable under the terms of the promotion.

PROVIDER SERVICES AND RESPONSIBILITIES. 4.1 The Provider agrees to provide quality health care in a cost efficient manner. 4.2 For the purpose of reimbursement, the Provider shall provide services to members inmates that are medically necessary and covered under the Health Insurance Plannecessary. 4.3 The Provider agrees to make reasonable effort to refer covered members inmates to those Network Providers, with which EGID the Department contracts, for medically necessary services that the Provider cannot or chooses not to provide. Failure of the Provider to use Network Providers will result in a review pursuant to the credentialing plan. 4.4 The Provider shall prescribe for EGID members the Department’s inmates medications identified on the adopted formulary or explain, in writing, on behalf of the member inmate to EGID the Department why it is medically inappropriate to do so. 4.5 The Provider shall participate in the preadmission certification, concurrent review, and prior authorization Prior Authorization procedures provided in Article VII and for purposes of reimbursement to abide by decisions resulting from those reviews subject to rights of reconsideration, review and appeal. 4.6 The provider Provider shall submit a current, complete and accurate Oklahoma Uniform Credentialing Application (ODH From 606) and EGID OUCA Supplement as allowed under OK §63-1-106.2 and Laws 1998, c. 210, § 1 which are incorporated herein by reference. The provider Provider shall notify EGIDthe Department’s Network Management Manager of any change in the information contained in the Application application within 15 fifteen (15) days of such change, including resolved litigation listed as “pending” on the original application. 4.7 The Provider shall reimburse EGID the Department for any overpayments made to the Provider within 30 days of the Provider's receipt of the overpayment notification. 4.8 The Provider shall submit to a patient record audit upon 48 hours advance notice. 4.9 The Provider shall participate in HELP/Wellness promotions sponsored by the EGID, at EGID’s allowable under the terms of the promotion.