Capitated Services. For all services for which a Health Plan receives a capitated payment, the Health Plan shall ensure that claims are processed and payment systems comply with the federal requirements set forth in 42 CFR 447.45; 42 CFR 447.46; the processing time frames in s. 641.3155, F.S.; and the requirements below:
Capitated Services. Services performed for a Member by a health care provider with whom the Plan has a contract, directly or indirectly, and where the contract transfers from the Plan the entire risk (without any stop loss or other risk retention by the Plan) that the service may generate a cost greater than the capitation payment.
Capitated Services. For all services for which a PSN receives a capitated payment, the PSN shall ensure that claims are processed and payment systems comply with the federal requirements set forth in 42 CFR 447.45, 42 CFR 447.46 and the requirements below:
Capitated Services. Physician Group agrees to provide Capitated Services to Enrollees selecting and assigned to Physician Group. The Capitated Services which are to be provided and which are the financial responsibility of Physician Group are described in Attachment A. Physician Group agrees to pay all claims for Capitated Services in accordance with State and Federal regulations governing claims payment by Health Plan and CMP Program. Physician Group agrees that, should Health Plan be required to compensate any provider for Capitated Services. Health Plan shall be reimbursed for such expenditures by Physician Group either through an offset against Capitation Fees, direct payment by Physician Group or combination thereof. Attachment A shall not be amended during the current contract period without mutual consent, except as may be required for continued compliance with Federal and State laws and regulations.
Capitated Services. Services with Special Arrangements and/or Payment of Out-Of-Plan Providers Pg 92 6.7.4.1 School Linked CHDP Services: Coordination of Care Pg 92 6.7.4.2 School Linked CHDP Services: Cooperative Arrangements Pg 92 6.7.4.3 School Linked CHDP Services: Subcontracts Pg 93 6.7.4.4 Early and Periodic Screening, Diagnosis and Treatment EPSDT Supplemental Services, Excluding Case Management Services Pg 93 6.7.4.5
Capitated Services. I. Capitated Services shall include the following services unless specifically excluded on Attachment A-2:
