Capitated Contracts Sample Clauses
A Capitated Contracts clause establishes a payment arrangement where a provider receives a fixed amount per patient for a specified period, regardless of the actual services provided. This clause typically applies to healthcare agreements between insurers and providers, where the provider assumes responsibility for delivering all necessary care to enrolled members within the agreed payment. By setting a predetermined payment structure, the clause helps control costs and incentivizes efficient care management, addressing the problem of unpredictable healthcare expenses.
Capitated Contracts. For certain Payors, Physician may be asked to accept capitation, a percentage of premiums, global fee or some other remuneration arrangement inconsistent with traditional fee for service arrangements. In such case, Physician will receive a written summary of the remuneration terms and other pertinent contract terms and will be given the opportunity to accept the terms of that arrangement by written amendment to this Agreement signed by both Physician and Network. Under capitated contracts, Physician agrees that IPA has the right to bind Physician to participate in Payer Plans which are consistent with the provisions set forth in Exhibit C and in which the reimbursement for Physician’s services equals or exceeds the reimbursement schedule set forth in Exhibit C, which is attached and hereby incorporated by reference and made part of this Agreement and as such Exhibit may from time- to-time be amended by mutual agreement. If the Payer Plan is consistent with the standards of the IPA, Physician shall have fifteen (15) days from receipt of such information to notify IPA in writing of his or her decision not to participate in this Payer Plan. If the Payer Plan is inconsistent with the Standards of the IPA, Physician shall have seven (7) days from receipt of such information to notify IPA in writing of his or her decision not to participate.
Capitated Contracts. 2.01 Commitments and Applicable Percentages 4.01(n) Certain Swap Contracts 5.03 Certain Authorizations 5.08(b) Existing Liens 5.08(c) Owned Real Property 5.08(d)(i) Leased Real Property (Lessee) 5.08(d)(ii) Leased Real Property (Lessor) 5.08(e) Existing Investments
Capitated Contracts. For any Covered Services for which the Physician is to be paid on a capitated basis, OMNI shall pay the Physician according to the compensation formula then existing, which formula shall be determined by the Operations Committee and shall take into account the enrollment and eligibility information provided to OMNI by Payors. The Physician shall be subject to any retroactive adjustments as required by the applicable Managed Care Contract. The Physician agrees to provide all services included within and required by the relevant Managed Care Contract. The Physician agrees to accept such capitation payments as payments in full, less the Managed Care Contracting Fee, and except for any applicable Copayments, for all services provided by the Physician. The Physician shall, within thirty (30) days following the end of each calendar month during the Term, submit to OMNI and, if requested by OMNI or required by the applicable Managed Care Contract, to the Payor, encounter data (in a form designated by OMNI) with respect to the Covered Services rendered by the Physician to Plan Members during the immediately preceding calendar month. Failure to submit encounter reports may result in withholding of the Physician's compensation by OMNI and/or the Payor.
Capitated Contracts. Quarterly, on or prior to the thirtieth (30th) day following the end of each calendar quarter, Credit Parties shall provide Lender a schedule listing all then existing Capitated Contracts and their expiration dates. In addition, promptly, but in any case not later than three (3) Business Days after any Credit Party obtains Knowledge thereof, Credit Parties shall advise Lender in writing of the termination or non-renewal of any Capitated Contract, any adjustment in the per-patient price or rate of payment under any Capitated Contract, or any adjustment, offset or deduction in respect of Capitated Contract Rights for retroactive additions and/or deletions of patients covered by Capitated Contracts during any consecutive 60-day period the payments under which Capitated Contract constituted, alone or together with payments under all other Capitated Contracts terminated or non-renewed or with respect to which any adjustment in the per-patient price or rate of payment under any Capitated Contract or any adjustment, offset or deduction in respect of Capitated Contract Rights for retroactive additions and/or deletions of patients covered by Capitated Contracts was made during such 60-day period, in excess of five percent (5%) of the aggregate payments under all Capitated Contracts during the immediately preceding twelve month period.