Common use of Provision of Covered Services Clause in Contracts

Provision of Covered Services. Provider agrees to render Covered Services to Members eligible for coverage under Title XVIII of the Social Security Act, as amended, in accordance with the terms and conditions of the MA PPO Program and BCBSM MA PPO Program requirements. Such BCBSM MA PPO Program requirements include the provisions of BCBSM’s applicable EOC, operational policies and procedures, utilization management program and quality management program requirements with which Provider shall comply in rendering Covered Services. BCBSM shall supply Provider with the MA PPO Program requirements not set forth in this Agreement through its MA PPO Provider Manual and any amendments thereto. Determination of Covered Services shall be governed by coverage guidelines established by BCBSM and the MA PPO Program, with BCBSM being solely responsible for final coverage determination, subject to the applicable appeal procedures.