Care Coordinator Fees Sample Clauses
The Care Coordinator Fees clause defines the payment terms and responsibilities related to compensating a care coordinator for their services. Typically, this clause outlines the amount, frequency, and method of payment, as well as any conditions under which fees may be adjusted or reimbursed. For example, it may specify whether fees are billed hourly, per service, or as a flat rate, and detail what services are included. The core function of this clause is to ensure transparency and agreement regarding financial obligations for care coordination, thereby preventing disputes over payment and clarifying expectations for both parties.
Care Coordinator Fees. Host Blues may also bill Claim Administrator for Care Coordinator Fees for Provider services which Claim Administrator will pass onto Employer as follows:
a) PMPM ▇▇▇▇▇▇▇▇; or
b) Individual Claim ▇▇▇▇▇▇▇▇ through applicable Care Coordination codes from the most current editions of either Current Procedural Terminology (“CPT”) published by the American Medical Association (“AMA”) or Healthcare Common Procedure Coding System (“HCPCS”) published by the US Centers for Medicare and Medicaid Services (“CMS”). As part of this Agreement, Claim Administrator and Employer will not impose Covered Person cost sharing for Care Coordinator Fees.
Care Coordinator Fees. Host Blues may also ▇▇▇▇ BCBSNE for Care Coordinator Fees for provider services which we will pass on to THE GROUP as follows:
1. PMPM ▇▇▇▇▇▇▇▇; or
2. Individual claim ▇▇▇▇▇▇▇▇ through applicable care coordination codes from the most current editions of either Current Procedural Terminology (CPT) published by the American Medical Association (AMA) or Healthcare Common Procedure Coding System (HCPCS) published by the U.S. Centers for Medicare and Medicaid Services (CMS). As part of this Agreement, BCBSNE and THE GROUP will not impose Covered Person cost sharing for Care Coordinator Fees.
Care Coordinator Fees. Host Blues may also bill Anthem for Care Coordinator Fees for Provider services which Anthem will pass on to Employer as follows:
Care Coordinator Fees. The Host Blue may also bill BCBSM for Care Coordinator Fees for Covered Services which BCBSM will pass on to Group as follows:
Care Coordinator Fees. Host Blues may also bill Claims Administrator for Care Coordinator Fees for provider services which we will pass on to Employer as follows:
Care Coordinator Fees. Host Blues may also ▇▇▇▇ BCBSNC for Care Coordinator Fees for provider services which we will pass on to Plan Sponsor, Plan Administrator, and/or Group Health Plan as follows: • PMPM ▇▇▇▇▇▇▇▇; or • Individual claim ▇▇▇▇▇▇▇▇ through applicable care coordination codes from the most current editions of either Current Procedural Terminology (CPT) published by the American Medical Association (AMA) or Healthcare Common Procedure Coding System (HCPCS) published by the U.S. Centers for Medicare and Medicaid Services (CMS). As part of this agreement, BCBSNC and Plan Sponsor, Plan Administrator, and/or Group Health Plan will not impose Member cost sharing for Care Coordinator Fees. DRAFT If BCBSNC has entered into a Negotiated Arrangement/Negotiated National Account Arrangement with a Host Blue to provide Value-Based Programs to Plan Sponsor, Plan Administrator, and/or Group Health Plan Members, BCBSNC will follow the same procedures for Value-Based Programs administration and Care Coordination Fees as noted in the BlueCard Program section. For negotiated arrangements, when Control/Home Licensees have negotiated with accounts to waive member cost sharing for care coordinator fees, the following provision will apply: As part of this agreement, BCBSNC and Plan Sponsor, Plan Administrator, and/or Group Health Plan may agree to waive Member cost sharing for care coordinator fees. BCBSNC offers several utilization management (UM) programs to optimize the health of the Group Health Plan’s Members by determining whether a Member is receiving Medically Necessary Services and Supplies, provided in the proper setting, for a reasonable length of time, and facilitating care when appropriate. These programs include prospective review, concurrent review, retrospective review, transplant management, health management programs and case management services. Qualified health care professionals administer these programs. Documented clinical review criteria are used in the administration of prospective, concurrent, and retrospective review programs. Inpatient admission and case management services are also applicable to mental health and/or chemical dependency treatment services if BCBSNC administers mental health and/or chemical dependency treatment benefits for the Group Health Plan. BCBSNC may modify its utilization management programs from time to time to assure proper utilization of services. This exhibit briefly outlines these programs. DRAFT
Care Coordinator Fees. Host Blues may also ▇▇▇▇ ▇▇▇▇▇▇▇▇▇ for Care Coordinator Fees for provider services which we will pass on to Employer as follows:
1.2.3.1. PMPM ▇▇▇▇▇▇▇▇; or
1.2.3.2. Individual claim ▇▇▇▇▇▇▇▇ through applicable care coordination codes from the most current editions of either Current Procedural Terminology (CPT) published by the American Medical Association (AMA) or Healthcare Common Procedure Coding System (HCPCS) published by the U.S. Centers for Medicare and Medicaid Services (CMS). DocuSign Envelope ID: CD93B45A-0105-43E7-9602-5AE5EB65AF29 DocuSign Envelope ID: 00C2B362-1FE5-4A7F-86FB-24039505711D As part of this Agreement/contract, BlueCross and Employer will not impose Member cost sharing for Care Coordinator Fees.
Care Coordinator Fees. For certain Value-Based Programs, Host Blues may also ▇▇▇▇ Anthem Blue Cross Life and Health for Care Coordinator Fees which we will pass on to Plan Sponsor. Based on the methods that Host Blues use to pass these fees on to Anthem Blue Cross Life and Health, Anthem Blue Cross Life and Health will invoice Plan Sponsor through: