Managed Care Contract definition

Managed Care Contract shall --------------------- include any Capitation/Case Rate Revenues contract, or any contracts based on a fee-for-service payment methodology or discounted fee-for-service reimbursement methodology and other agreements with third party payors, alternative delivery systems or other purchasers of group health care services.
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Managed Care Contract means the agreement between the agency and an MCO to provide prepaid contracted services to enrollees.
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Managed Care Contract means the agreement between the agency and an MCO to provide prepaid con- tracted services to enrollees.
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Examples of Managed Care Contract in a sentence

  • The schedule should show charges, contractual adjustments, and revenues by payor plan and contract (e.g., Medicare, each Medicaid agency payor, each Medicaid Managed care contract).

  • Managed care contract participation (or lack thereof) shall not be considered as a qualification or disqualification for Medical and Dental Staff membership.

  • Managed care contract oversight focuses on eight functional areas, which align to the scope of the Medicaid and Children’s Health Insurance Program (CHIP) Managed Care Final Rule established by CMS in 2016 and updated in 2020 to achieve a better balance between appropriate federal oversight and state flexibility.

  • In previous proposal bids submitted by AC Transit District, Third Party Administration Services and Managed care contract were asked to be submitted separately.

  • Managed care contract language specifying program integrity and fraud and abuse prevention, detection, and reporting requirements for health plans contracting with MassHealth, including the requirement to have a compliance plan, designed to guard against fraud and abuse.

  • Managed care contract requirements are typically not detailed enough to delineate every aspect of service coordination, including medical and social services, and they only address the activities of the health plan.

  • Notes:(1) The Group’s capital investment during the year included S$3.1 million of new equipment for its five factories, S$0.2 million of renovation and S$0.4 million of computers and IT software.

  • Managed care contract language specifying program integrity and fraud and abuse prevention, detection, and reporting requirements for health plans contracting with MassHealth,including the requirement to have a compliance plan, designed to guard against fraud and abuse.Do managed health care plans with which your program contracts have written plans?Yes NoPlease Explain: [500] 2.

  • Flexibility in meeting client needs is its priority. Managed care contract improvement is a fundamental part of BLS’ service; provided at no additional cost.Infusion Services Audit and collection of underpayments for hospital and home infusion services. Separate staff experienced in infusion claims is dedicated to the payment audit process for these claims. Experience with these claims is critical, especially for complex and expensive infusion services.


More Definitions of Managed Care Contract

Managed Care Contract means an agreement with a managed care organization or other Third Party providing for a Discount other than an agreement with respect to a Government Health Care Program.
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Managed Care Contract means a contract or agreement for Hospital Services between ENH and a Payor, including but not limited to rates, definitions, terms, conditions, policies, and pricing methodology (e.g., per diem, discount rate, and case rate).
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Managed Care Contract means the agreement between the agency and an MCO or PAHP to provide prepaid contracted services to enroll- ees.
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Managed Care Contract means any agreement, contract or commitment of or with (directly or indirectly through an independent practice association or other health care provider network) a third party payor, including a federal or state government program (e.g. Medicare or Medicaid), insurance company, self-insured employer, healthcare service plan, non-profit hospital insurance plan or health maintenance organization, for the provision of health care services to any person or persons or for reimbursement of health care services rendered to such person or persons.
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Related to Managed Care Contract

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Managed care entity means either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).

  • Managed care means a system that provides the coordinated delivery of services and supports that are necessary and appropriate, delivered in the least restrictive settings and in the least intrusive manner. Managed care seeks to balance three factors:

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Managed Care Organization (MCO) means a contracted health delivery system providing capitated or prepaid health services, also known as a Prepaid Health Plan (PHP). An MCO is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law. An MCO may be a Chemical Dependency Organization (CDO), Dental Care Organization (DCO), Mental Health Organization (MHO), or Physician Care Organization (PCO).

  • HMO means health maintenance organization.

  • Medicare cost report means CMS-2552-10, the cost report for electronic filing of

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other entity administering the Medicaid program and a health care operation under which the health care operation agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • Continuing care contract means, as stated in RCW 70.38.025, a contract providing a person, for the duration of that person's life or for a term in excess of one year, shelter along with nursing, medical, health-related, or personal care services, which is conditioned upon the transfer of property, the payment of an entrance fee to the provider of such ser- vices, or the payment of periodic charges for the care and ser- vices involved. A continuing care contract is not excluded from this definition because the contract is mutually termina- ble or because shelter and services are not provided at the same location.

  • Medicaid program means the medical assistance

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Managed health care system means: (a) Any health care

  • Child care facility or “facility” means a child care center, a preschool, or a registered child development home.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • Health care facility or "facility" means hospices licensed

  • Provider contract means any contract between a provider and a carrier (or a carrier's network,

  • HCFA means the United States Health Care Financing Administration and any successor thereto.

  • Program Manual means the United States Department of Agriculture, Animal and Plant Health Inspection Service, Plant Protection and Quarantine, Gypsy Moth Program Manual, 1994 edition.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • MCO means an organization having a certificate of authority or certificate of registration from the 11 Washington State Office of Insurance Commissioner that contracts with HCA under a comprehensive 12 risk contract to provide prepaid health care services to eligible HCA Enrollees under HCA managed 13 care programs.

  • Medicare Provider Agreement means an agreement entered into between CMS (or other such entity administering the Medicare program on behalf of the CMS) and a health care provider or supplier, under which such health care provider or supplier agrees to provide services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • PCI DSS means the Payment Card Industry Data Security Standards.