Common use of CAPITATION Clause in Contracts

CAPITATION. A. Exhibit D (incorporated by reference herein), sets forth the Capitation payments. The applicable Capitation payment for each Member assigned to PARTICIPATING MEDICAL GROUP, shall be paid monthly, prorated in accordance with Member eligibility. B. The Capitation payment to PARTICIPATING MEDICAL GROUP for each mother will begin on the date the mother is assigned to PARTICIPATING MEDICAL GROUP and will continue up to sixty (60) days after delivery. C. In the event BLUE CROSS assigns a mother to PARTICIPATING MEDICAL GROUP retroactively, the Capitation payment will be made from the date the mother is assigned to PARTICIPATING MEDICAL GROUP. BLUE CROSS will discourage retroactive additions beyond a ninety (90) day period. D. The Capitation payment to PARTICIPATING MEDICAL GROUP will be made for each infant for professional services related to normal pregnancy and cesarean section delivery including the administration of pediatric immunizations, periodic checkups, other covered professional services and covered outpatient services. The Capitation payment made under this Section 7.01.D will begin from the date of birth and continue for a period of up to twenty-four (24) months after birth. E. The provision of professional services for treatment of complications for an infant on an inpatient basis will be paid at the rates set forth at in the then current Blue Cross of California Prudent Buyer Plan Participating Physician Agreement fee schedule for the applicable region. “Complications” means it is Medically Necessary to admit the infant to a Level II or Level III intensive care newborn nursery (hereafter referred to as “Complications”). PARTICIPATING MEDICAL GROUP shall ▇▇▇▇ BLUE CROSS for services rendered in conjunction with the treatment of Complications within twelve (12) months of date of service.