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:
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Examples of CalOptima Direct in a sentence

  • 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.

  • 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.

  • 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.

  • 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.

  • 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 will pay County for covered non-PPS medical services provided to CalOptima Direct Members.

  • 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.

  • Sick care (i.e. non-CHDP/PPS services) will be provided to CalOptima Direct patients only.

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.