Common use of Services Other Than Capitated Professional Services Clause in Contracts

Services Other Than Capitated Professional Services. (a) In the event that Group provides Emergency Services, Urgent Care Services, or authorized Covered Services to Blue Shield’s HMO members who are not Members hereunder (and for whom such services are not the financial responsibility of another capitated Blue Shield medical group), Group shall xxxx Blue Shield for the provision of such services as set forth in the Provider Manual. Blue Shield shall pay Group for the services described in this Paragraph 7.2 at the rates set forth in Exhibit E., minus any applicable Copayment. All such xxxxxxxx shall be delivered to Blue Shield within sixty (60) days of the date of service. Blue Shield may deny payment for any bills not received by Blue Shield within one hundred eighty (180) days of the date of service and in such event, neither Group nor Group Providers may xxxx the Member for such services. (b) Notwithstanding the foregoing subpart (a), in the event that Blue Shield is not the primary payor, Group shall not make any demand for payment from Blue Shield until all primary sources of payment have been pursued. Blue Shield’s obligation hereunder with respect to such Covered Services provided to members who are not Members hereunder, shall be limited to the amount, if any, which when added to the amount obtained by Group from such primary payors, equals the amount of compensation to which Group is entitled under this Agreement for such services.

Services Other Than Capitated Professional Services. (a) In the event that Group provides Emergency Services, Urgent Care Services, or authorized Covered Services to Blue Shield’s HMO members who are not Members hereunder (and for whom such services are not the financial responsibility of another capitated Blue Shield medical group), Group shall xxxx Blue Shield for the provision of such services as set forth in the Provider Manual. Blue Shield shall pay Group for the services described in this Paragraph 7.2 at the rates set forth in Exhibit E., minus any applicable CopaymentCo-payment. All such xxxxxxxx shall be delivered to Blue Shield within sixty (60) days of the date of service. Blue Shield may deny payment for any bills not received by Blue Shield within one hundred eighty (180) days of the date of service and in such event, neither Group nor Group Providers may xxxx the Member for such services. (b) Notwithstanding the foregoing subpart (a), in the event that Blue Shield is not the primary payor, Group shall not make any demand for payment from Blue Shield until all primary sources of payment have been pursued. Blue Shield’s obligation hereunder with respect to such Covered Services provided to members who are not Members hereunder, shall be limited to the amount, if any, which when added to the amount obtained by Group from such primary payors, equals the amount of compensation to which Group is entitled under this Agreement for such services.

Services Other Than Capitated Professional Services. (a) In the event that Group provides Emergency Services, Urgent Care Services, or authorized Covered Services to Blue Shield’s HMO members who are not Members hereunder (and for whom such services are not the financial responsibility of another capitated Blue Shield medical group), Group shall xxxx bxxx Blue Shield for the provision of such services as set forth in the Provider Manual. Blue Shield shall pay Group for the services described in this Paragraph 7.2 at the rates set forth in Exhibit E., minus any applicable Copayment. All such xxxxxxxx bxxxxxxx shall be delivered to Blue Shield within sixty (60) days of the date of service. Blue Shield may deny payment for any bills not received by Blue Shield within one hundred eighty (180) days of the date of service and in such event, neither Group nor Group Providers may xxxx bxxx the Member for such services. (b) Notwithstanding the foregoing subpart (a), in the event that Blue Shield is not the primary payor, Group shall not make any demand for payment from Blue Shield until all primary sources of payment have been pursued. Blue Shield’s obligation hereunder with respect to such Covered Services provided to members who are not Members hereunder, shall be limited to the amount, if any, which when added to the amount obtained by Group from such primary payors, equals the amount of compensation to which Group is entitled under this Agreement for such services.