Common use of Compensation to Other Providers of PPG Capitated Services Clause in Contracts

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 of PPG Capitated Services to Commercial Medicare 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, the PPG’s subcontract terms, or the 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 of PPG Capitated Services to Commercial Medicare 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, the PPG’s subcontract terms, or the 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 Commercial Medi-Cal HMO and Commercial POS Members assigned to PPGPPG as set forth in this Agreement. In the event that PPG does not process and pay eligible claims submitted to PPG for Capitated Services within the applicable time limits, HMO . HEALTH NET may pay such claims at the lesser of HMOHEALTH NET’s contract rate with such provider, if any, PPG’s subcontract terms. Medi-Cal rates, or provider’s billed charges. HMO charges and shall deduct any such claim the 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 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, Capitation as set forth in the Operations Manual.