Transitioning between Non-Network and Network Providers Sample Clauses

Transitioning between Non-Network and Network Providers. EOHHS recognizes that members may need to, at times, transition between non-network and network providers to continue to receive needed substance use disorder services. This can occur when members first enroll in a Health Plan, when members change Health Plans, or at other times. The Contractor agrees to have written policies and procedures for transitioning members between non-network and network providers to assure continuity of care, including paying for one or more transition visits with a non-network provider.
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Transitioning between Non-Network and Network Providers. The State recognizes that members may need at times to transition between non- network and network providers to continue to receive necessary dental services. This can occur when members first enroll in RIte Smiles, when members change dental plans, or at other times. Contractor agrees to have written policies and procedures for transitioning members between non-network and network providers to assure continuity of care, including paying for one (1 ) or more transition visits with a non- network provider.
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Transitioning between Non-Network and Network Providers. The State recognizes that members may need to, at times, transition between non-network and network providers to continue to receive needed substance abuse services. This can occur when members first enroll in a Health Plan, when members change Health Plans, or at other times. Contractor agrees to have written policies and procedures for transitioning members between non-network and network providers to assure continuity of care, including paying for one or more transition visits with a non-network provider.
Sample 1

Related to Transitioning between Non-Network and Network Providers

  • NON-NETWORK PROVIDER is a provider that has not entered into a contract with us or any other Blue Cross and Blue Shield plan. For pediatric dental care services, non-network provider is a dentist that has not entered into a contract with us or does not participate in the Dental Coast to Coast Network. For pediatric vision hardware services, a non-network provider is a provider that has not entered into a contract with EyeMed, our vision care service manager.

  • How Non-network Providers Are Paid If you receive care from a non-network provider, you are responsible for paying all charges for the services you received. You may submit a claim for reimbursement of the payments you made. For the limited circumstances listed below, your copayment and deductible will apply at the network level of benefits: • emergency care (emergency room, urgent care and ambulance services); • we specifically approve the use of a non-network provider for covered healthcare services, see Network Authorization in Section 5 for details; • covered healthcare services are rendered by a non-network provider at a network facility outside of your control; • otherwise, as required by law. For those circumstances where we cover services from a non-network provider, we reimburse you or the non-network provider, less any copayments and deductibles, up to the lesser of: • our allowance; • the non-network provider’s charge; or • the benefit limit. You are responsible for the deductible, if one applies, and the copayment, as well as any amount over the benefit limit that applies to the service you received. You are liable for the difference between the amount that the non-network provider bills and the payment we make for covered healthcare services. Generally, we send reimbursement to you, but we reserve the right to reimburse a non-network provider directly. We reimburse non-network provider services using the same guidelines we use to pay network providers. Generally, our payment for non-network provider services will not be more than the amount we pay for network provider services. If an allowance for a specific covered healthcare service cannot be determined by reference to a fee schedule, reimbursement will be based upon a calculation that reasonably represents the amount paid to network providers. For emergency services, we reimburse non- network providers, in accordance with R.I. Gen. Laws § 27-18-76, the greater of our allowance, our usual guidelines for paying non-network providers, or the amount that would be paid under Medicare, less any copayments or deductibles. Payments we make to you are personal. You cannot transfer or assign any of your right to receive payments under this agreement to another person or organization, unless the R.I. General Law §27-20-49 (Dental Insurance assignment of benefits) applies. For information about network authorization requests to seek covered healthcare services from a non-network provider when the covered healthcare service cannot be provided by a network provider, please see Network Authorization in Section 5.

  • Verizon OSS Services Access to Verizon Operations Support Systems functions. The term “Verizon OSS Services” includes, but is not limited to: (a) Verizon’s provision of ECI Usage Information to ECI pursuant to Section 8.3 of this Attachment; and, (b) “Verizon OSS Information”, as defined in Section 8.1.4 of this Attachment.

  • Availability of Verizon Telecommunications Services 3.1 Verizon will provide a Verizon Telecommunications Service to CBB for resale pursuant to this Attachment where and to the same extent, but only where and to the same extent that such Verizon Telecommunications Service is provided to Verizon’s Customers.

  • Service Management Effective support of in-scope services is a result of maintaining consistent service levels. The following sections provide relevant details on service availability, monitoring of in-scope services and related components.

  • Use of Verizon Telecommunications Services 2.1 Verizon Telecommunications Services may be purchased by Connectel under this Resale Attachment only for the purpose of resale by Connectel as a Telecommunications Carrier. Verizon Telecommunications Services to be purchased by Connectel for other purposes (including, but not limited to, Connectel’s own use) must be purchased by Connectel pursuant to other applicable Attachments to this Agreement (if any), or separate written agreements, including, but not limited to, applicable Verizon Tariffs.

  • Conversion of Wholesale Services to Network Elements or Network Elements to Wholesale Services Upon request, AT&T shall convert a wholesale service, or group of wholesale services, to the equivalent Network Element or Combination that is available to TWTC pursuant to Section 251 of the Act and under this Agreement or convert a Network Element or Combination that is available to TWTC pursuant to Section 251 of the Act and under this Agreement to an equivalent wholesale service or group of wholesale services offered by AT&T (collectively “Conversion”). AT&T shall charge the applicable nonrecurring switch-as-is rates for Conversions to specific Network Elements or Combinations found in Exhibit A. AT&T shall also charge the same nonrecurring switch-as-is rates when converting from Network Elements or Combinations. Any rate change resulting from the Conversion will be effective as of the next billing cycle following AT&T’s receipt of a complete and accurate Conversion request from TWTC. A Conversion shall be considered termination for purposes of any volume and/or term commitments and/or grandfathered status between TWTC and AT&T. Any change from a wholesale service/group of wholesale services to a Network Element/Combination, or from a Network Element/Combination to a wholesale service/group of wholesale services, that requires a physical rearrangement will not be considered to be a Conversion for purposes of this Agreement. AT&T will not require physical rearrangements if the Conversion can be completed through record changes only. Orders for Conversions will be handled in accordance with the guidelines set forth in the Ordering Guidelines and Processes and CLEC Information Packages as referenced in Sections 1.14.1 and 1.14.2 below.

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