Medical Case Management Services definition
Examples of Medical Case Management Services in a sentence
To the extent such services are Non-Covered Services, but are Medical Case Management Services, Contractor must refer the Member to an appropriate Participating or Non-Participating Provider and manage and coordinate the services.
The Supplier will provide the same Health Summary/Transfer Tool to the assigned Medical Case Management Agency for children eligible for Medical Case Management Services.
Medical Case Management Services means services provided by a Primary Care Provider to ensure the coordination of Medically Necessary health care services, the provision of preventive services in accordance with established standards and periodicity schedules and the continuity of care for Medi-Cal enrollees.
To the extent such services are not Coordinated Care Services, but are Medical Case Management Services, Contractor must refer the Member to an appropriate Participating or Non-Participating Provider and manage and coordinate the services.
NMCM programs may not have as their objective improving health outcomes, as that is a function of Medical Case Management Services and is not covered under this agreement.
Non- Medical Case Management Services may also include assisting eligible clients to obtain access to other public and private programs for which they may be eligible, such as Medicaid, Medicare Part D, State Pharmacy Assistance Programs, Pharmaceutical Manufacturer’s Patient Assistance Programs, other state or local health care and supportive services, or health insurance Marketplace plans.