![]() ![]() Care's members who have been under the ongoing care of a terminating specialist or an entire specialty group. The contract amendment also requires specialists and specialty group practices to provide timely notification to L.A. Allow plan to use provider group/practitioners/facilities to use performance data (e.g., quality improvement activities, public reporting to consumers, preferred status designation on the network, and reduced member cost sharing).Care has recently amended practitioner and provider contracts to encourage practitioners to freely communicate with patients about their treatment, including medication treatment options, regardless of benefit coverage limitations and to require that provider groups, practitioners and facilities: Requirement that practitioners and facilities cooperate with QI activities provide access to their medical records, to the extent permitted by state and federal law, maintain confidentiality of member information and records, and allow plan to use provider group/practitioner performance data. If you would like paper copies of any of the above information, please contact us at 1-866-LA-CARE6 ( 1-86). You can find additional information regarding notification of specialist termination in your provider manual. Our contracts with specialists and specialty group practices outline which party is responsible for notifying those members affected by the termination prior to the effective date of termination. Care’s members who have been under the ongoing care of a terminating specialist or an entire specialty group. Maintain the confidentiality of member information and records.Care and its Plan Partners access to practitioner or facility medical records, to the extent permitted by state and federal law. Care and Plan Partner Quality Improvement activities. Care has recently amended practitioner and provider contracts to encourage practitioners to freely communicate with patients about their treatment, including medication treatment options, regardless of benefit coverage limitations and to require that practitioners and facilities: If a claim is denied for timely filing but the provider can demonstrate “good cause for delay” through the provider dispute resolution process, Serra Community Medical Clinic, Inc will accept and adjudicate the claim as if it had been submitted within the provider’s claim filing timeframe.Policy encouraging practitioners to freely communicate with patients about their treatment, regardless of benefit coverage limitations and specialist termination notification Providers contracting for the Medi-Cal line of business have 180 days from the last day of the month of service to submit initial Medi-Cal claims. If the Provider Services Agreement (PSA) provides for a claim-filing deadline that is greater than 120 days, the longer timeframe will continue to apply unless and until the contract is amended. Claims not received within the timely filing period will be denied. If Serra Community Medical Clinic, Inc is not the primary payer under coordination of benefits (COB) rules, the claim submission period begins on the date the primary payer has paid or denied the claim. Effective January 1, 2004, Serra Community Medical Clinic, Inc will accept claims from contracting providers if they are submitted within 120 calendar days from the date of service except as described below.
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