Mandatory Members. Retroactive changes to a Member's PCP should only be made if it is medically necessary or there are other circumstances which necessitate a retroactive change. HMO must pay claims for services provided by the original PCP. If the original PCP is paid on a capitated basis and services were provided during the period for which capitation was paid, HMO cannot recoup the capitation.
Appears in 6 contracts
Samples: Agreement and Plan of Merger (Centene Corp), Agreement and Plan of Merger (Centene Corp), Amerigroup Corp
Mandatory Members. Retroactive changes to a Member's PCP should only be made if it is medically necessary or there are other circumstances which that necessitate a retroactive change. HMO must pay claims for services provided by the original PCP. If the original PCP is paid on a capitated basis and services were provided during the period for which capitation was paid, HMO cannot recoup the capitation.
Appears in 1 contract
Samples: Amerigroup Corp
Mandatory Members. Retroactive changes to a Member's PCP should only be made if it is medically necessary or there are other circumstances which necessitate a retroactive change. HMO must pay claims claim's for services provided by the original PCP. If the original PCP is paid on a capitated basis and services were provided during the period for which capitation was paid, HMO cannot recoup the capitation.
Appears in 1 contract
Samples: Centene Corp
