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.
Appears in 4 contracts
Samples: Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
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 are shall be met within the CONTRACTOR’s provider networknetwork of providers. The CONTRACTOR shall also have a system to refer Members to Non-Contract providers who are not Network Providers if Providers providers with the necessary qualifications or certifications do not participate in the CONTRACTOR’s network. The CONTRACTOR and nonOut-Contract of-Network Providers must coordinate with the CONTRACTOR with respect to payment. The CONTRACTOR must ensure that the cost to the Member is no greater than it would be if the services were furnished within the CONTRACTOR’s network.
Appears in 3 contracts
Samples: Medicaid Long Term Services Agreement (Amerigroup Corp), Medicaid Managed Care Services Agreement, Medicaid Managed Care Services Agreement
Specialty Providers. The CONTRACTOR shall contract with a sufficient number of specialists with the applicable range of expertise to ensure that the needs of the Members are met within the CONTRACTOR’s provider network. The CONTRACTOR shall also have a system to refer Members to Non-Contract Providers if Providers providers with the necessary qualifications or certifications do not participate in the CONTRACTOR’s network. The CONTRACTOR and nonOut-Contract Providers of-network providers must coordinate with the CONTRACTOR 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.
Appears in 1 contract
