Specialty Providers. The CONTRACTOR shall contract with a sufficient number of specialists with the applicable range of expertise to ensure that the needs of Members are met within the CONTRACTOR’s provider network. The CONTRACTOR shall have a system to refer Members to Non-Contract Providers if Providers with the necessary qualifications or certifications do not participate in the CONTRACTOR’s network. The CONTRACTOR and non-Contract Providers must coordinate with respect to payment. The CONTRACTOR must ensure that cost to the Member is no greater than it would be if the services were furnished within the CONTRACTOR’s network.
Specialty Providers. FHFS requires all specialty providers to request a CHAMPUS/TRICARE Prime Member to sign a release of medical information at each visit, to include ancillary services associated with each visit whereby the PCM and/or the MTF Commanders are designated as the recipients of the medical records. Specialty providers are required to submit the medical records to the PCM and/or MTF Commander within 14 days for all routine referrals.
Specialty Providers. The CONTRACTOR shall contract with a sufficient number of specialists with the applicable range of expertise to ensure that the needs of CONTRACTOR members shall be met within the CONTRACTOR network of providers. The CONTRACTOR shall also have a system to refer members to providers who are not affiliated with the MCO network if providers with the necessary qualifications or certifications do not participate in the network.
Specialty Providers. The specialty provider must comply with all applicable statutory and regulatory requirements of the SCHIP program and be Board Certified or Admissible. Specialty Provider responsibilities shall include at a minimum:
4.9.4.1 Providing consultation summaries or appropriate periodic progress notes to the member's PCP on a timely basis, following a referral or routinely scheduled consultative visit; and
4.9.4.2 Notifying the member's PCP when scheduling a hospital admission or any other procedure requiring the PCP's approval. The Contractor shall ensure the availability of Specialty Providers as appropriate for pediatric members. The Contractor shall ensure access to appropriate service settings for members needing medically high risk perinatal care, including both prenatal and neonatal care.
Specialty Providers. 41. To help increase the supply of specialty providers (including providers who treat sexual victims, sexual offenders, and individuals with developmental disabilities), Defendants will devise and implement, within 120 days of the entry of the Settlement Agreement, a means of allowing RBHAs to contract with certain certified Masters level behavioral health professionals (who meet the specific privileging requirements established by ADHS/DBHS) to provide behavioral health services and independently invoice for services rendered within the scope of their practice. The certified Masters level behavioral health professionals permitted to contract and bill independently pursuant to the provisions of this paragraph are Certified Independent Social Workers, Certified Professional Counselors and Certified Marriage and Family Therapists.
Specialty Providers. The specialty provider must comply with all applicable statutory and regulatory requirements of the Medicaid program; be eligible to participate in the Medicaid program; and be Board Certified or Admissible.
4.18.2.1. Specialty Provider responsibilities shall include at a minimum:
a. Providing consultation summaries or appropriate periodic progress notes to the member's primary care provider on a timely basis, following a referral or routinely scheduled consultative visit; and
b. Notifying the member's primary care provider when scheduling a hospital admission or any other procedure requiring the primary care provider's approval.
Specialty Providers. Specialty providers are providers that offer limited care in a specialized environment or provide health care in a focused specialty area. A “specialty provider” is defined as a provider that only serves: A population defined by the practice specialty (e.g. OB/GYN, STD clinic, family planning); or A specific age group within the general population of children 0 through 18 years of age. Specialty providers only need to supply and administer the specific vaccines recommended for the population they serve. A birthing hospital that supplies only the birth dose of hepatitis B vaccine is an example of a specialty provider. All children 0 through 18 years of age who are eligible for the federal Vaccines for Children (VFC) program, the Idaho Immunization Assessment, and federal funds for designated targeted populations may receive vaccines supplied by the IIP. Patient eligibility must be screened and documented for every child at each immunization visit. Patient eligibility status information must be retained and easy to retrieve in the patient’s medical record for three (3) years. V FC Eligibility All providers must screen every child for VFC eligibility at each immunization visit. VFC eligibility must be documented for each dose of vaccine administered. All children who are 0 through 18 years of age, and meet one of the following criteria, are considered VFC eligible: Native American or Alaska Native; Enrolled in Medicaid; Have no health insurance; or Are underinsured. Underinsured children have private health insurance but the coverage does not include vaccines; the coverage includes only selected vaccines (the child is VFC eligible for non-covered vaccines); or, children whose insurance caps vaccine coverage at a certain amount (once the coverage amount is reached, these children are categorized as underinsured). With the implementation of the Affordable Care Act (ACA), it is rare for a child to meet the underinsured eligibility criteria for the VFC program. Therefore, unless insurance coverage for vaccines is verified by the provider prior to administration of vaccine, for the purposes of the VFC program, these children are considered insured and not eligible to receive VFC vaccines at that immunization encounter. Underinsured children are eligible to receive VFC vaccine only through a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or deputized Public Health District. Private providers must inform parents of underinsured ...
Specialty Providers. Foundation requires all specialty -------------------- Providers to request a TRICARE Prime Beneficiary to sign a release of medical information at each site visit, to include ancillary services associated with each visit whereby the PCM and/or the MTF Commanders are designated as the recipients of the medical records. Specialty Providers are required to submit the medical records to the PCM and/or MTF Commander within 14 days for all routine referrals.
Specialty Providers. Specialty providers are providers who offer limited care in a specialized environment or provide health care in a focused specialty area. A “specialty provider” is defined as a provider that only serves: · A population defined by the practice specialty (e.g. OB/GYN, STD clinic, family planning); or · A specific age group within the general population of children 0 through 18 years of age. Specialty providers only need to supply and administer the specific vaccines recommended for the population they serve. A birthing hospital that supplies only the birth dose of hepatitis B vaccine is an example of a specialty provider. All children 0 through 18 years of age who are eligible for the federal Vaccines for Children (VFC) program, the Idaho Immunization Assessment, and federal funds for designated targeted populations may receive vaccines supplied by the IIP. Patient eligibility must be screened and documented for every child at each immunization visit. Patient eligibility status information must be retained and easy to retrieve in the patient’s medical record for three (3) years.
Specialty Providers. Relates to a wide range of health care services in virtually every medical specialty and subspecialty.
