Common use of Encounter Clause in Contracts

Encounter.  A service or item provided to a patient through the health care system. Examples include but are not limited to: o Office visits o Surgical procedures o Radiology (including professional and/or technical components) o Durable medical equipment o Emergency transportation to a hospital o Institutional stays (inpatient hospital, rehabilitation stays) o HealthCheck screens  A service or item not directly provided by the PIHP, but for which the PIHP is financially responsible. An example would include an emergency service provided by an out-of-network provider or facility.  A service or item not directly provided by the PIHP, and for which no claim is submitted but for which the PIHP may supplement its encounter data set. Such services might include HealthCheck screens for which no claims have been received and if no claim is received, the PIHP must have conducted a medical chart review. Examples of services or items the PIHP may include are: o HealthCheck Services o Lead Screening and Testing o Immunizations Services or items as used above include those services and items not covered by FCMH Program, but which the PIHP chooses to provide as part of its product. Examples include educational services, certain over-the-counter drugs, and delivered meals.

Encounter.  A service or item provided to a patient through the health care system. Examples include but are not limited to: o Office visits o Surgical procedures o Radiology (including professional and/or technical components) o Durable medical equipment o Emergency transportation to a hospital o Institutional stays (inpatient hospital, rehabilitation stays) o HealthCheck screens  • A service or item not directly provided by the PIHP, but for which the PIHP is financially responsible. An example would include an emergency service provided by an out-of-network provider or facility.  • A service or item not directly provided by the PIHP, and for which no claim is submitted but for which the PIHP may supplement its encounter data set. Such services might include HealthCheck screens for which no claims have been received and if no claim is received, the PIHP must have conducted a medical chart review. Examples of services or items the PIHP may include are: o HealthCheck Services o Lead Screening and Testing o Immunizations Services or items as used above include those services and items not covered by FCMH Program, but which the PIHP chooses to provide as part of its product. Examples include educational services, certain over-the-counter drugs, and delivered meals.

Encounter.  A service or item provided to a patient through the health care system. Examples include but are not limited to: o Office visits o Surgical procedures o Radiology (including professional and/or technical components) o Durable medical equipment o Emergency transportation to a hospital o Institutional stays (inpatient hospital, rehabilitation stays) o HealthCheck screens  • A service or item not directly provided by the PIHPHMO, but for which the PIHP HMO is financially responsible. An example would include an emergency service provided by an out-of-network provider or facility.  • A service or item not directly provided by the PIHPHMO, and for which no claim is submitted but for which the PIHP HMO may supplement its encounter data set. Such services might include HealthCheck screens for which no claims have been received and if no claim is received, the PIHP HMO must have conducted a medical chart review. Examples of services or items the PIHP HMO may include are: o HealthCheck Services o Lead Screening and Testing o Immunizations Services or items as used above include those services and items not covered by FCMH ProgramBadgerCare Plus and Medicaid SSI, but which the PIHP HMO chooses to provide as part of its managed care product. Examples include educational services, certain over-the-counter drugs, and delivered meals.

Encounter.  A service or item provided to a patient through the health care system. Examples include but are not limited to: o Office visits o Surgical procedures o Radiology (including professional and/or technical components) o Durable medical equipment o Emergency transportation to a hospital o Institutional stays (inpatient hospital, rehabilitation stays) o HealthCheck screens  A service or item not directly provided by the PIHPHMO, but for which the PIHP HMO is financially responsible. An example would include an emergency service provided by an out-of-network provider or facility.  A service or item not directly provided by the PIHPHMO, and for which no claim is submitted but for which the PIHP HMO may supplement its encounter data set. Such services might include HealthCheck screens for which no claims have been received and if no claim is received, the PIHP HMO must have conducted a medical chart review. Examples of services or items the PIHP HMO may include are: o HealthCheck Services o Lead Screening and Testing o Immunizations Services or items as used above include those services and items not covered by FCMH ProgramBadgerCare Plus and Medicaid SSI, but which the PIHP HMO chooses to provide as part of its managed care product. Examples include educational services, certain over-the-counter drugs, and delivered meals.