CalOptima Direct definition

CalOptima Direct. (COD) means a program CalOptima administers for CalOptima Members not enrolled in a Health Network. COD consists of two components:

Examples of CalOptima Direct in a sentence

  • Orangewood residents who become Medi-Cal eligible with a CalOptima aid code as a result of their placement shall initially be enrolled in CalOptima Direct.

  • Eligibility/ Client Services County/Family Planning will provide family planning services to FamilyPACT eligible CalOptima Direct or CalOptima Health Network members choosing to seek such services outside of their Health Network or CalOptima.

  • CalOptima recognizes that CalOptima Direct or CalOptima Health Network members have the right to choose to seek their family planning services outside of the Health Network/CalOptima.

  • CalOptima Direct or the member’s Health Network shall reimburse all services medically necessary to diagnose and stabilize the patient, without prior authorization.

  • Children may remain in CalOptima Direct or, at the discretion of the caregiver; CalOptima shall assist with transition of the minor into the Health Network of the caregiver’s choice.

  • CalOptima Direct or the member’s Health Network shall reimburse CHOC Emergency Department and any related provider services for an MSE without prior authorization, regardless of the outcome of the MSE.

  • For CalOptima Direct Members, PDS Hospital Liaison will contact CalOptima case management.

  • Reimbursement shall be available for authorized Medical Respite Care for CalOptima Members following the 90-day Whole-Person Care Recuperative Care stay, whether the Member is assigned to CalOptima Direct, to a CalOptima Shared Risk Health Network, to a CalOptima HMO Health Network, or to a CalOptima Physician-Hospital Consortium.

  • Notification County/JHS - Orangewood staff shall notify the Health Network or CalOptima Direct as soon as practical when a resident has received non-emergent off-site services.

  • Notification County/JHS - Orangewood staff shall notify the Health Network or CalOptima Direct as soon as practical when a resident has received Notification information that is received shall be reviewed for coordination of care and case Category County/JHS – Orangewood SSA/OCFC CalOptima/Health Networks non-emergent off-site services.

Related to CalOptima Direct

  • Objective medical evidence means reports of examinations or treatments; medical signs which are anatomical, physiological, or psychological abnormalities that can be observed; psychiatric signs which are medically demonstrable phenomena indicating specific abnormalities of behavior, affect, thought, memory, orientation, or contact with reality; or laboratory findings which are anatomical, physiological, or psychological phenomena that can be shown by medically acceptable laboratory diagnostic techniques, including but not limited to chemical tests, electrocardiograms, electroencephalograms, X-rays, and psychological tests;

  • Medical cannabis pharmacy means the same as that term is defined in Section 26-61a-102.

  • Drug therapy management means the review of a drug therapy regimen of a patient by one or more pharmacists for the purpose of evaluating and rendering advice to one or more practitioners regarding adjustment of the regimen.

  • Designated mental health professional means a mental health

  • Medical management technique means a practice which is used to control the cost or utilization of health care services or prescription drug use. The term includes, without limitation, the use of step therapy, prior authorization or categorizing drugs and devices based on cost, type or method of administration.

  • School nurse means a registered professional nurse with Maine Department of Education certification for school nursing.

  • Licensed mental health professional or "LMHP" means a physician, licensed clinical psychologist, licensed professional counselor, licensed clinical social worker, licensed substance abuse treatment practitioner, licensed marriage and family therapist, certified psychiatric clinical nurse specialist, licensed behavior analyst, or licensed psychiatric/mental health nurse practitioner.

  • Medical cannabis means the same as that term is defined in Section 26-61a-102.

  • Medical cannabis card means the same as that term is defined in Section 26-61a-102.

  • Modern biotechnology means the application of:

  • Non-Administrator Ambulatory Surgical Facility means an Ambulatory Surgical Facility which does not meet the definition of an Administrator Ambulatory Surgical Facility.

  • Career teacher means a teacher who:

  • DEVELOPMENTAL SERVICES means therapies, typically provided by a qualified professional using a treatment plan, that are intended to lessen deficiencies in normal age appropriate function. The therapies generally are meant to limit deficiencies related to injury or disease that have been present since birth. This is true even if the deficiency was detected during a later developmental stage. The deficiency may be the result of injury or disease during the developmental period. Developmental services are applied for sustained periods of time to promote acceleration in developmentally related functional capacity. This plan covers developmental services unless specifically listed as not covered.

  • Nursing diagnosis means a judgment made by a registered nurse, following a nursing assessment of individuals and groups about actual or potential responses to health problems, which forms the basis for determining effective nursing interventions.

  • Medical history means information regarding any:

  • Radiation therapist means a person, other than a Licensed Practitioner or Nuclear Medicine Technologist, who applies radiation to humans for therapeutic purposes under the supervision of a Licensed Practitioner;

  • Step therapy means a protocol or

  • Technical Committee means the body established in accordance with article VII;

  • Biometrics means a technique of personal identification that is based on physical, physiological or behavioural characterisation including blood typing, fingerprinting, DNA analysis, retinal scanning and voice recognition;

  • Medical Foods means nutritional substances in any form that are:

  • MEDICAL STAFF LEADER means any Medical Staff Officer, department chair, section chief, and committee chair.

  • Asset Management Company/UTI AMC/AMC/Investment Manager means the UTI Asset Management Company Limited incorporated under the Companies Act, 1956, (1 of 1956) [replaced by The Companies Act, 2013 (No.18 of 2013)] and approved as such by Securities and Exchange Board of India (SEBI) under sub-regulation (2) of Regulation 21 to act as the Investment Manager to the schemes of UTI Mutual Fund.

  • Medical personnel means those persons assigned, by a Party to the conflict, exclusively to the medical purposes enumerated under sub-paragraph (e) or to the administration of medical units or to the operation or administration of medical transports. Such assignments may be either permanent or temporary. The term includes:

  • Program Director means an individual who has complete responsibility for the day to day function of the program. The Program Director is the highest level of decision making at a local, program level.

  • DS Electric generation service that is provided at retail pursuant to the Applicable Legal Authorities under the Company’s retail electric tariffs and under any other agreements or arrangements between the Company and Customers, to any Customer that is not being served by an EGS. Default Allocation Assessment – shall have the meaning ascribed to it under the PJM Agreements. Delivery Period – The delivery period specified in an Appendix C Transaction Confirmation. Delivery Point – Means the applicable zone of the Company as designated by PJM. DS Customer(s) – Retail customers who are provided Default Service pursuant to the terms of this Agreement, the Applicable Legal Authorities and the Company’s retail tariffs.

  • Medical Advisory Committee means the Medical Advisory Committee established by the Board as required by the Public Hospitals Act;