Compensation to Other Providers of PPG Capitated Services Sample Clauses
The 'Compensation to Other Providers of PPG Capitated Services' clause defines how payments are made to healthcare providers who deliver services under a capitation arrangement within a physician provider group (PPG). Typically, this clause outlines the method for distributing capitation payments among various providers, specifying criteria such as service type, provider role, or patient assignment. For example, it may detail how primary care physicians and specialists are compensated from the capitation pool based on the services they render to enrolled patients. The core function of this clause is to ensure fair and transparent allocation of capitated funds, thereby preventing disputes and promoting efficient collaboration among providers within the PPG.
Compensation to Other Providers of PPG Capitated Services. PPG shall compensate all providers who render PPG Capitated Services to Commercial HMO and Commercial POS Members assigned to PPG. In the event that PPG does not process and pay eligible claims submitted to PPG for Capitated Services within applicable time limits, HMO may pay such claims at the lesser of HMO’s contract rate with such provider, if any, PPG’s subcontract terms, or provider’s billed charges. HMO shall deduct any such claim amounts paid from PPG’s Capitation, as set forth in the Operations Manual.
Compensation to Other Providers of PPG Capitated Services. PPG shall compensate all providers who render PPG Capitated Services to Healthy Families Members assigned to PPG. In the event that PPG does not process and pay eligible claims submitted to PPG for Capitated Services within applicable time limits. HEALTH NET may pay such claims at the lesser of HEALTH NET’S contract rate with such provider, if any, PPG’s subcontract terms or provider’s billed charges. HEALTH NET shall deduct any such claim amounts paid from PPG’s Capitation, as set forth in the Operations Manual.