Covered Services definition

Covered Services means all or a part of those medical and health services set forth in rule 441—86.14(514I).

Covered Services means Medically Necessary health care items and services covered under a Benefit Plan.

Covered Services means those health care services for which Members are entitled to receive benefits, including reimbursement, under the terms of the applicable Plan.

Examples of Covered Services in a sentence

• The CHC-MCO must enroll to participate in the MA Program, arrange for the provision of Medically Necessary Covered Services to its Participants, and comply with all Federal and State laws generally and specifically governing participation in the MA Program.

• In accordance with 42 CFR § 447.15, Provider shall accept United’s payment as payment in full except for any applicable cost-sharing requirements under the State Contract, and shall not bill or balance bill Covered Persons for Covered Services provided during the Covered Person’s enrollment period.

• Provider understands and agrees that each claim Provider submits to United constitutes a certification that the claim is true and accurate to the best of Provider’s knowledge and belief and that the Covered Services are 1) Medically Necessary and 2) have been provided to the Covered Person prior to submitting the claim.

• The CHC-MCO may provide individually tailored supportive items or services in addition to Covered Services where such services are determined by the CHC-MCO through the PCSP process to be appropriate for supporting a Participant in remaining in his or her home- or community-based setting.

• Start Date — The first date on which the CHC-MCO is operationally responsible and financially liable for the provision of Covered Services to a Participant.

More Definitions of Covered Services

Covered Services means medically necessary mental health and substance abuse care as defined under the terms of the Program, except to the extent that such care is otherwise limited or excluded under the Program.

Covered Services means the services, supplies, or accommodations for which the Plan provides Benefits.

Covered Services means those health care services which are (i) identified as payable in Certificate(s), (ii) medically necessary as defined in such Certificates, and (iii) ordered and performed by a TRUST PRACTITIONER or other health care PRACTITIONER licensed to order and perform such services.

Covered Services means, except as otherwise provided in the Member’s benefit plan, a complete and routine eye examination including, but not limited to, visual acuities, internal and external examination, (including dilation where professionally indicated,) refraction, binocular function testing, tonometry, neurological integrity, biomicroscopy, keratometry, diagnosis and treatment plan, and when authorized by state law and covered by a Plan, medical eye care, diagnosis, treatment and eye care management services, and when applicable, ordering and dispensing plan eyeglasses from a DAVIS laboratory.

Covered Services means services for which reimbursement

Covered Services means those medical, surgical and related health care services which Practice and Participating Physicians provide to, or arrange for, Enrollees pursuant to a Health Benefit Plan and this Agreement.

Covered Services means the health and medical services described in Articles 2 and 11 of this Chapter as being eligible for reimbursement by AHCCCS.