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PROFESSIONAL STANDARDS

Providers must render covered services in a quality and cost-effective manner in recognition of Carelon’s standards and procedures as described in this provider manual; in accordance with generally-accepted medical standards and all applicable laws and regulations; and pursuant to the same standards as services rendered to the provider’s other patients. The provider must not discriminate against any member on the basis of race, color, gender, sexual orientation, age, religion, national origin, handicap, health status or source of payment in providing services under this agreement.

Providers may not arbitrarily deny or reduce the amount, duration, or scope of a required service solely because of the diagnosis, type of illness, or condition.