Outside of the scope of the services definition

Outside of the scope of the services means all medical benefits outside the set of services defined at OAC 317:25-7 and the provisions of the SoonerCare Choice contracts in the SoonerCare Program.
Sample 1Sample 2Sample 3
Outside of the scope of the services means all medical
Sample 1Sample 2Sample 3
Outside of the scope of the services means all medical benefits outside the set of services defined at OAC 317:25-7 and the provisions of the SoonerCare Choice contracts in the SoonerCare Program.(b) Assignment in fee-for-service. The OHCA's Medicaid State Plan provides that participation in the medical program is limited to providers who accept, as payment in full, the amounts paid by OHCA plus any deductible, coinsurance, or co-payment required by the State Plan to be paid by the member and make no additional charges to the member or others.(1) OHCA presumes acceptance of assignment upon receipt of an assigned claim. This assignment, once made, cannot be rescinded, in whole or in part by one party, without the consent of the other party.(2) Once an assigned claim has been filed, the member must not be billed and the member is not responsible for any balance except the amount indicated by OHCA. The only amount a member may be responsible for is a co-payment, or the member may be responsible for services not covered under the medical programs. In any event, the member should not be billed for charges on an assigned claim until the claim has been adjudicated or other notice of action received by the provider. Any questions regarding amounts paid should be directed to OHCA, Provider Services.(3) When potential assignment violations are detected, the OHCA will contact the provider to assure that all provisions of the assignment agreement are understood. When there are repeated or uncorrected violations of the assignment agreement, the OHCA is required to suspend further payment to the provider.(c) Assignment in SoonerCare. Any provider who holds a fee for service contract and also executes a contract with a provider in the SoonerCare Choice program must adhere to the rules of this subsection regarding assignment.(1) If the service provided to the member is outside of the scope of the services outlined in the SoonerCare Contract, then the provider may bill or seek collection from the member.(2) In the event there is a disagreement whether the services are in or out of the scope of the contracts referenced in (1) of this subsection, the Oklahoma Health Care Authority shall be the final authority for this decision. The provider seeking payment under the SoonerCare Program may appeal to OHCA under the provisions of OAC 317:2-1-2.1.(3) Violation of this provision shall be grounds for a contract termination in the fee-for-service and SoonerCare programs.(d) Cost Sharing-Copayment. Section 1902(a)(14) ...
Sample 1Sample 2

Related to Outside of the scope of the services

  • Scope of Services or “Scope of Work” means the work to be performed by the Proposer or Consultant as described in Section 2.0 of this RFP, as amended thereto.

  • Consultancy Services means the Consultancy Services described in Schedule A;

  • Assistive technology service means any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device. The term includes:

  • Hosting Services means the provision, administration, and maintenance of servers and related equipment, the provision of bandwidth at the hosting facility, and the operation of the Application for access by Customer Users to be provided by the relevant hosting service provider.

  • Cable Services means the transmission by cable of programs including retransmission by cable of any satellite television signals.

  • Child support services means any civil, criminal or administrative action taken by the Division of

  • Consulting Services means services of an advisory and intellectual nature provided by consultants using their professional skills to study, design, organize, and manage projects, encompassing multiple activities and disciplines, including the crafting of sector policies and institutional reforms, specialist advice, legal advice and integrated solutions, change management and financial advisory services, planning and engineering studies, and architectural design services, supervision, social and environmental assessments, technical assistance, and programme implementation;

  • Restricted Activities means and includes the following:

  • Support Services means support in relation to the use of, and the identification and resolution of errors in, the Hosted Services, but shall not include the provision of training services;

  • Development Services “Target Market”; “Investment Areas”; and “Targeted Populations” have the meanings ascribed to such terms in 12 C.F.R. 1805.104.

  • Interscholastic Activities means athletic or non-athletic/academic activities where students compete on a school vs. school basis.

  • Internet Services means that part of the Data & Internet Services which is accessible via the public internet. This includes internet access, email facilities, web-page facilities and any other related internet facility or services that we may provide from time to time. This specifically does not refer to wide area networking services that are not accessible via the public internet.

  • Project Services means architectural, engineering services, land surveying, construction management at-risk services, ancillary technical services or other construction-related services determined by the board to be required by the project.

  • Beta Services means Our services that are not generally available to customers.

  • Cemetery services means cremations, grave openings and closings, and installation of grave memorials.

  • Data Services The Customer will receive a discount equal to 25% for the following Data Services: Access: Standard VBS2 Guide local loop charges for DS-1 Access and DS-3 Access Service.

  • Platform Services means the products and services that Platform Users receive from a Stripe Connect Platform, regardless of whether fees are charged (e.g., web development, customer support or hosting services).

  • link services means all new services necessary to connect the internal services to the bulk services; and