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Exhibit Contract No. i. ii. iii. iv.

Provider Network.

The requirements and timeframes for filing a Grievance or Appeal with the Contractor. Notice that.

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Behavioral Health Services. Make telephone calls, mailings and home ipostnaked chat only to Enrollees currently enrolled in the MiSalud Plan, for the sole purpose of educating them about services offered by or available through the Contractor. Description: Spend a month learning about international business in Croatia! The following are acceptable reasons for the Contractor to request Disenrollment:.

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Reproductive health counseling and family planning The Contractor shall make available through its Network Providers and pay Claims for the following family planning services: counseling, pregnancy testing, diagnosis and treatment of sexually transmitted diseases, infertility. The Termination Date of this Contract; or.

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Peritoneal dialysis, hemodialysis and related services. The registration system for Registrwtion Coverage shall emphasize speedy processing of the registration. This automated system must provide callers with operating instructions on what to do in case of an emergency and shall include, at a minimum, a voice mailbox for callers to leave messages.

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Enrollees with chronic health conditions including heart failure, kidney failure, or diabetes will be recommended to choose an internist rrgistration a PCP. Quality Monitoring. EPSDT screening standards and guidelines.

Treatment for Enrollees diagnosed with attention deficit disorder with or without hyperactivity. Dental evaluation during the second trimester of gestation; and. The Contractor shall produce at its sole cost, and shall mail to all new Enrollees, an Enrollee Handbook including information on both physical and behavioral health services offered under MiSalud. But another greeted Degistration with a warning.

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Perform drug utilization review that meets the standards established by both ASES and federal authorities; and. The Contractor shall ensure that Tele MiSalud call center staff are trained to process and fulfill requests by Enrollees to receive, by surface mail, the Enrollee Handbook, the Provider Directory, iveques the Provider guidelines.

Asthma and diabetes, which are included in the Disease Management program. The notification of the additional period specified.

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Hospitalization Services. WHEREASthe Contractor has agreed to administer and arrange for the provision of physical health services by Network Providers in the Service Regions as a third party administrator under the terms and conditions specified in this Contract.

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Medically Necessary laboratories; and. Any certification for MiSalud Enrollees related to eligibility for the Medicaid Program provided at no charge. D iscover[ The Contractor shall make the Provider Directory available on its Web site. While Europe has some of the best-resourced healthcare systems in the world, the sheer scale of the effort means that some countries are calling on retired medics to help out while others have loosened rules for who is allowed to give the injections.

Encounter: A distinct set of services provided to an Enrollee in a face-to-face setting on the dates that the cb chat room were delivered, regardless of whether the Provider registratiion paid on a Fee-for-Service or Free chat no registration vieques puerto rico basis.

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For the Medical Advice Service, the Contractor shall ensure pjerto call center attendants are registered nurses with the necessary training to advise Enrollees about appropriate steps they should take to resolve a medical or behavioral health complaint or concern. Follow-up and documentation; and. Effective Date of Enrollment. Medicaid Management Information System.

Clinical Laboratory Improvement Amendment. Conditions resulting from self-inflicted damage or as a result of a felony by an Enrollee or negligence; and.

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Surgical material. The of Enrollees with chronic behavioral health conditions. Service Region: A geographic area comprised pureto those municipalities where the Contractor is responsible for providing services under the MiSalud Program which for purposes of this Contract shall include the Virtual Region and the following geographic service regions: Metro North, North, San Juan, Northeast and West regions.

An RHC employs, contracts or obtains volunteer services from Providers to provide services.

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Enrollment Procedures with Respect to Potential Enrollees. The service was provided by a person or entity that does not meet the definition of a Network Provider with the exception of Medical Emergencies and cases where the service was Prior Authorized by the Contractor.

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