Providing Covered Services Sample Clauses

The 'Providing Covered Services' clause defines the obligations of a party to deliver specific services that are included under the terms of the agreement. It typically outlines which services are considered 'covered,' the standards or requirements for their delivery, and any limitations or exclusions that may apply. For example, it may specify that only certain types of maintenance or support are included, while others require additional fees. This clause ensures both parties have a clear understanding of what services will be provided, reducing the risk of disputes over service expectations and scope.
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.
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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.
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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.
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Related to Providing Covered Services

  • Covered Services You will receive Covered Services under the terms and conditions of this Contract only when the Covered Service is: • Medically Necessary; • Provided by a Participating Provider for in-network coverage; • Listed as a Covered Service; • Not in excess of any benefit limitations described in the Schedule of Benefits section of this Contract; and • Received while Your Contract is in force.

  • Non-Covered Services The Contractor shall refer Members to Providers enrolled in the Medicaid Fee-for- Service delivery system for all Medically Necessary Services not covered by the Contractor under the MississippiCAN Program. The Contractor shall have written policies and procedures for the referral of Members for non-covered services, which shall provide for the smooth transition to Out-of-network Providers and assistance to Members in obtaining a new PCP, if appropriate. These procedures shall be applicable to the referral of Members to Out-of- network Providers, as necessary, upon Disenrollment, regardless of the reasons for Disenrollment.

  • Required Services Consultant agrees to perform the services, and deliver to City the “Deliverables” (if any) described in the attached Exhibit A, incorporated into the Agreement by this reference, within the time frames set forth therein, time being of the essence for this Agreement. The services and/or Deliverables described in Exhibit A shall be referred to herein as the “Required Services.”

  • Provision of Covered Services MCP is responsible for authorizing Medically Necessary Covered Services, including NSMHS, ensuring MCP’s Network Providers coordinate care for Members as provided in the applicable Medi-Cal Managed Care Contract, and coordinating care from other providers of carve-out programs, services, and benefits.

  • Shared Services CUPE agrees to adopt a shared services model that will allow other Trusts to join the shared services model. The shared services office of the Trust is responsible for the services to support the administration of benefits for the members, and to assist in the delivery of benefits on a sustainable, efficient and cost effective basis recognizing the value of benefits to the members.