Providing Covered Services. Provider shall provide to Members those Covered Services which Provider is licensed and qualified to provide. (“Provider Services”) Consistent with Section 2240.4 of Title 10 of the California Code of Regulations, Provider’s primary consideration shall be the quality of the health care services rendered to Members.
Providing Covered Services. Provider shall follow the authorization and referral procedures set forth in the Provider Manual for the authorization and payment of Covered Services. Provider shall provide authorized Covered Services to Members consistent with the scope of his/her license to practice. Provider shall consult with and seek further authorization from Health Plan or Member’s Primary Care Practitioner if he/she believes that additional treatment or tests are needed beyond those initially authorized. Provider understands and agrees that Health Plan’s authorization of services does not constitute a guarantee of Health Plan payment for such services.
Providing Covered Services. Provider shall follow the authorization and referral procedures set forth in the Provider Manual for the authorization and payment of Covered Services. Provider shall furnish Covered Services through qualified personnel and, where applicable, appropriately credentialed health care professionals. Provider shall furnish to Members only such Covered Services as Health Plan has contracted with Provider to provide, and as to which Provider is legally qualified to provide and as are consistent with Provider's customary practice and staff credentials. Provider shall consult with and seek further authorization from Health Plan or Member’s Primary Care Practitioner if it is believed that additional treatment or tests are needed beyond those initially authorized. Provider understands and agrees that Health Plan’s authorization of services does not constitute a guarantee of Health Plan’s payment for such services.
