Provision of Services and Professional Requirements Sample Clauses

Provision of Services and Professional Requirements. 1. Physician shall make necessary and appropriate arrangements to assure the availability of physician services to his/her Covered Person patients on a twenty-four (24) hours per day, seven (7) days per week basis, including on-call arrangements to assure coverage of his/her Covered Person patients after-hours or when Physician is otherwise unavailable. On-call arrangements shall be with another physician Plan Provider to the extent feasible. If transfer to another physician Plan Provider is not feasible, Physician shall ensure that such non-participating physician will cooperate with and accept the findings of peer review procedures of the applicable Plan as they relate to services provided to Covered Persons and that such non-participating physician will seek prior authorization for all hospitalizations and referrals of Covered Persons, to the extent required under the applicable Plan. For services rendered by covering physicians on behalf of Physician, VIVA Health shall reimburse covering physicians at the fee rate for the applicable Plan specified in Attachment A. Physician shall assure that the covering physician will accept rate as payment in full and will not, under any circumstances, bill Covered Persons for Covered Services, except Out of Pocket Costs or as otherwise permitted under this Agreement and by applicable law. 2. At all times during the term of this Agreement, Physician hereby represents and warrants to VIVA Health as follows: (a) Physician shall maintain: (i) an unrestricted license to practice medicine in the state or states in which Physician provides medical services to Covered Persons, (ii) an unrestricted Drug Enforcement Agency Certificate, and (iii) an unrestricted State Controlled Substances Certificate; (b) Physician shall satisfy VIVA Health's board certification or board eligibility requirements; and (c) neither Physician nor any of his/her employees, contractors, or agents have been and throughout the term of this Agreement will not be suspended, excluded, barred or sanctioned by the Medicare or Medicaid programs or other federal or state program (as defined at 42 U.S.C. § 1320a-7b(f)) or convicted of a health care offense that falls within the ambit of 42 U.S.C. §§ 1320a-7(a) or 1320a-7(b). 3. Physician shall provide Emergency Services to Covered Persons without the requirement of prior authorization of any kind. Physician shall contact VIVA Health within 24 hours of the provision of Emergency Services (including any emerge...

Provision of Services and Professional Requirements. You agree to make necessary and appropriate arrangements to ensure the availability of medical care services to PCP Covered Persons on a twenty-four (24) hour per day, seven (7) day per week basis, including arrangements to ensure coverage for PCP Covered Persons after hours or when you are otherwise absent. You will ensure that covering providers participate with Southeast Services, Inc. Additionally, you agree to comply with the access requirements in 12 Virginia Administrative Code 0-000-000 E, F and G and 0-000-000 D. Such requirements include: (i) ensure the availability of routine appointments for non-emergency or non-urgent care within two weeks of the PCP Covered Person´s request and preventive care appointments, including routine physical examinations, within 60 days of the PCP Covered Person´s request; and (ii) provide clear notice to PCP Covered Persons of provisions for urgent care or emergency services when you are not available after hours.

Provision of Services and Professional Requirements. 1. [Reserved] 2. At all times during the term of this Agreement, AHP hereby represents and warrants to VIVA Health as follows: (a) AHP shall maintain an unrestricted license or other adequate authorization or qualification to provide health care services within his/her specialty in the state or states in which AHP provides medical services to Covered Persons; (b) AHP shall satisfy VIVA Health's credentialing requirements; and (c) neither AHP nor any of his/her employees, contractors, or agents have been and throughout the term of this Agreement will not be suspended, excluded, barred or sanctioned by the Medicare or Medicaid programs or other federal or state program (as defined at 42 U.S.C. § 1320a- 7b(f)) or convicted of a health care offense that falls within the ambit of 42 U.S.C. §§ 1320a-7(a) or 1320a-7(b). 3. AHP shall provide Emergency Services to Covered Persons without the requirement of prior authorization of any kind. AHP shall contact VIVA Health within 24 hours of the provision of Emergency Services or as soon as thereafter practical. 4. AHP agrees that all duties performed hereunder shall be consistent with the prevailing standard of care, and that such duties shall be performed in accordance with the customary rules of ethics and conduct of the bodies, formal or informal, governmental or otherwise, from which Allied Health Professionals seek advice and guidance or to which they are subject to licensing, authorization, and control. 5. AHP agrees that he/she will utilize such additional qualified personnel as are available and appropriate for effective and efficient delivery of health care and shall at all times be responsible for such personnel. 6. AHP agrees to participate in such programs of quality assurance, utilization review and continuing education as are required by VIVA Health, an applicable Plan, and state and federal regulatory authorities. 7. AHP agrees to notify VIVA Health within seven (7) days of the: (a) loss, restriction or recommended adverse action against his/her hospital privileges or prerogatives in any hospital; (b) loss, restriction or recommended adverse action against his/her license or authorization to provide health care services within his/her specialty; (c) suspension, exclusion, bar, or sanction of AHP or any of his/her employees, contractors, or agents by the Medicare or Medicaid programs or other federal or state program (as defined at 42 U.S.C. § 1320a-7b(f)) or conviction of AHP or any of his/her employees,...