Common use of Referrals to Specialty Care Providers Clause in Contracts

Referrals to Specialty Care Providers. If Provider is a Primary Care Physician (“PCP”), Provider will arrange for referrals to specialty care providers pursuant to the referral policies and procedures as described in the Provider Manual. Providers who are specialty care providers will comply with referral requirements, including but not limited to the following: (a) Maintain good communications with the Covered Person’s PCP and contact the Covered Person’s PCP if diagnosis or treatment required differs significantly from expectations indicated on the referral form; (b) Respond in a timely manner to the Covered Person’s PCP with summary of findings, test results, and recommendations following referral; (c) Notify the Covered Person’s PCP of the need for secondary referral within the TennCare network of physicians. Referral to other physicians outside of the TennCare network should be preceded by consultation and agreement with the Covered Person’s PCP unless in the case of a medical emergency; and (d) Hospitalize a Covered Person only with the knowledge and agreement of the Covered Person’s PCP or in the case of medical emergency.

Appears in 3 contracts

Samples: Provider Agreement, Provider Agreement, Provider Agreement

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Referrals to Specialty Care Providers. If Provider is a Primary Care Physician (“PCP”), Provider will arrange for referrals to specialty care providers pursuant to the referral policies and procedures as described in the Provider Manual. Providers who are specialty care providers will comply with referral requirements, including but not limited to the following: (ai) Maintain good communications with the Covered Person’s PCP and contact the Covered Person’s PCP if diagnosis or treatment required differs significantly from expectations indicated on the referral form; (bii) Respond in a timely manner to the Covered Person’s PCP with summary of findings, test results, and recommendations following referral; (ciii) Notify the Covered Person’s PCP of the need for secondary referral within the TennCare network of physicians. Referral to other physicians outside of the TennCare network should be preceded by consultation and agreement with the Covered Person’s PCP unless in the case of a medical emergency; and (div) Hospitalize a Covered Person only with the knowledge and agreement of the Covered Person’s PCP or in the case of medical emergency.

Appears in 3 contracts

Samples: Provider Agreement, Provider Agreement, Provider Agreement

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Referrals to Specialty Care Providers. If Provider is a Primary Care Physician (“PCP”), Provider will arrange for referrals to specialty care providers pursuant to the referral policies and procedures as described in the Provider Manual. Providers who are specialty care providers will comply with referral requirements, including but not limited to the followingthefollowing: (a) Maintain good communications with the Covered Person’s PCP and contact the Covered Person’s PCP if diagnosis or treatment required differs significantly from expectations indicated on the referral form; (b) Respond in a timely manner to the Covered Person’s PCP with summary of findings, test results, and recommendations following referral; (c) Notify the Covered Person’s PCP of the need for secondary referral within the TennCare network of physicians. Referral to other physicians outside of the TennCare network should be preceded by consultation and agreement with the Covered Person’s PCP unless in the case of a medical emergency; and (d) Hospitalize a Covered Person only with the knowledge and agreement of the Covered Person’s PCP or in the case of medical emergency.

Appears in 1 contract

Samples: Provider Agreement

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