EMTALA
Health Plan shall pay for emergency care services provided to Members in the emergency department of Hospital at the negotiated or billed rate for any medical screening examination or other evaluation required by state or federal law which is necessary to determine whether an emergency medical condition exists.  Hospital shall use reasonable commercial efforts to notify Health Plan within 24 hours or within the next business day of the Member presenting at the Hospital.  Health Plan shall provide Electronic Notification Protocol 278N interoperability at its own expense to facilitate this notification requirement. Failure to notify in the case of an Emergency shall not result in any payment reduction to the Hospital or any Physician rendering Emergency or Post-Stabilization services.

(a) Health Plan shall not require prior authorization for emergency services for treatment of any emergency medical condition.  

(b) Health Plan shall pay for services which originated as emergent services following treatment or stabilization of an emergency medical or dental condition.