Use of Participating Providers. Unless the requirement is expressly waived in the applicable Product Description, each Physician shall admit Beneficiaries to the Children’s Memorial Hospital or other health care facility for treatment only when such admissions are certified in advance by the applicable Payor or its designee, except for cases of Emergency. In the case of services rendered in an Emergency, Physician shall follow the procedures outlined in the Policy and Procedure Manual or Payor contract.
Use of Participating Providers. Except in the case of Emergency Services or where Hospital obtains the prior authorization of Health Plan, Hospital will utilize Health Plan’s Participating Providers to provide Hospital Services to Members. Should Health Plan have no Participating Provider to render Medically Necessary Hospital Services, Health Plan will use reasonable efforts to coordinate an out of network agreement with an appropriate provider.
Use of Participating Providers. 12.1 Except in the case of a medical emergency, PPM shall require PPM Physicians to admit, refer and cooperate with the transfer of Members for Covered Services only to providers designated, specifically approved or under contract with HUMANA.
12.2 In the event that a PPM Physician provides a Member non-covered services or refers a Member to an out-of-network provider without pre-authorization from HUMANA, PPM shall require PPM Physicians prior to the provision of such non covered services or such out-of-network referral, to inform the Member: (I) of the services to be provided or referral to be made; (II) that HUMANA will not pay (or may pay a reduced benefit in the case of HUMANA's point of service (POS) and/or preferred provider organization (PPO) products) or be liable financially for such non covered service or out-of-network referral and (III) that Member will be responsible PHYSICIAN PRACTICE MANAGEMENT PARTICIPATION AGREEMENT financially for non-covered service(s) and/or out-of-network(s) referral that are requested by the Member. PPM acknowledges and agrees and shall require PPM Physicians to acknowledge and agree that the failure to inform Member(s) in accordance with this Section 12.2 may result in the PPM's and/or PPM Physician's responsibility and financial liability for the cost of such non-covered service(s) and/or out-of-network referral incurred by HUMANA.
Use of Participating Providers. Unless the requirement is expressly waived in the applicable Product Description, each Physician shall admit Beneficiaries to hospitals for treatment only when such admissions are certified in advance by the applicable Payer, except in cases of Emergency. Physician agrees further that, should he/she arrange for coverage with a non-Participating Physician, Physician shall ensure that the non- Participating (i) will accept as full payment for services delivered to Beneficiaries the lesser of the non-Participating Physician's fee-for-service charge or the maximum fees for such Covered Services set by the applicable Payer; and (ii) will accept the quality assurance, utilization review and discharge planning, referral management and claims payment review procedures described in the applicable Product Description.
Use of Participating Providers. Provider shall admit or refer Members for covered services only to providers designated or specially approved by Humana.
Use of Participating Providers. Professional Provider agrees that, except in the event of an emergency, a Member’s specific request or the unavailability of a Participating Provider, Professional Provider shall use best efforts, and shall cause each Practitioner to use best efforts to, direct Members as needed for additional health care service to Professional Providers participating in the Member’s Product. When ordering drugs and medical items or supplies for Members, Professional Provider and each Practitioner shall use Participating Providers participating in the Member’s Product. Professional Provider and each Practitioner shall document in the Member’s records any and all reasons why a Member was directed to a non-Participating Professional Provider, and shall inform the Member that there may be additional costs to the Member resulting from the use of a non- Participating Professional Provider. Professional Provider shall notify Highmark of any referral to a non-Participating Professional Provider.
Use of Participating Providers. Except in the case of Emergency Services or when Provider obtains prior authorization, Provider will only utilize Participating Providers to provide Covered Services. Provider will notify Health Plan so that Health Plan can determine the appropriate provider to perform the services if a Participating Provider is not available.
Use of Participating Providers. Provider agrees that Patients are entitled to the professional medical judgment of their physicians on Medically Necessary treatment options that may be appropriate for their condition or disease. CIN shall not restrict Provider and its Participating Physicians from engaging in medical communications with Patients.
Use of Participating Providers. 12.1 Except in the case of a medical emergency, PPM shall require PPM Physicians to admit, refer and cooperate with the transfer of Members for Covered Services only to providers designated, specifically approved or under contract with HUMANA.
12.2 In the event that a PPM Physician provides a Member non-covered services or refers a Member to an out-of-network provider without pre-authorization from HUMANA, PPM shall require PPM Physicians prior to the provision of such non-covered services or such out-of-network referral, to inform
Use of Participating Providers. PROVIDER agrees to make best efforts to make referrals and admissions to other participating providers in the Global Health Claim Services Preferred Provider Organization. GHCS agrees to keep PROVIDER informed of other providers participating in the Global Health Claim Services Preferred Provider Organization (PPO). In the event the network is accessed by a Health Management Organization (HMO) the fees allowed by such HMO Contract will be presented at the time in a separate document. GHCS will request authorization from the provider to participate in such program(s).
