Non-Capitated Services. 9.01 Non-Capitated Services, as defined in this Article, shall include Covered Medical Services, as set forth in the applicable Benefit Agreement and as authorized or referred by PARTICIPATING MEDICAL GROUP. The Covered Medical Services encompassed in Non-Capitated Services are delineated in Exhibit A(1) and include, but are not limited to:
Non-Capitated Services a. For all electronically submitted claims for non-capitated services, the Health Plan shall:
Non-Capitated Services. The following Texas Medicaid program services have been excluded from the services included in the calculation of HMO capitation rate: THSteps Dental (including Orthodontia) Early Childhood Intervention Case Management/Service Coordination MHMR Targeted Case Management Mental Health Rehabilitation Pregnant Women and Infants Case Management THSteps Medical Case Management Texas School Health and Related Services Texas Commission for the Blind Case Management Tuberculosis Services Provided by TDH-approved providers (Directly Observed Therapy and Contact Investigation) Vendor Drugs (out of office drugs) Medical Transportation TDHS Hospice Services Refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. TDHS/HMO CONTRACT August 11, 1999
Non-Capitated Services. The following Texas Medicaid program ---------------------- services have been excluded from the services included in the calculation of HMO capitation rate: THSteps Dental (including Orthodontia) Early Childhood Intervention Case Management/Service Coordination MHMR Targeted Case Management Mental Health Rehabilitation Pregnant Women and Infants Case Management THSteps Medical Case Management Texas School Health and Related Services Texas Commission for the Blind Case Management Tuberculosis Services Provided by TDH-approved providers (Directly Observed Therapy and Contact Investigation) Vendor Drugs (out-of-office drugs) Medical Transportation TDHS Hospice Services 1999 Renewal Contract Xxxxxx Service Area August 9, 1999 36 Refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. Although HMO is not responsible for paying or reimbursing for these non-capitated services, HMO remains responsible for providing appropriate referrals for Members to obtain or access these services.
Non-Capitated Services. 9.01 Billing for Non-Capitated Services shall be as follows:
Non-Capitated Services a. For all electronically submitted Claims for non-capitated services, the PSN shall:
Non-Capitated Services. The following Texas Medicaid program services have been excluded from the services included in the calculation of HMO capitation rate: - THSteps Dental (including Orthodontia); - Early Childhood Intervention Case Management/Service Coordination; - MHMR Targeted Case Management; - Mental Health Rehabilitation; - Pregnant Women and Infants Case Management; - THSteps Medical Case Management; - Texas School Health and Related Services; - Texas Commission for the Blind Case Management; - Tuberculosis Services Provided by HHSC-approved providers (Directly Observed Therapy and Contact Investigation); - Vendor Drugs (out-of-office drugs); - Medical Transportation; and - TDHS Hospice Services. Refer to relevant chapters in the Provider Procedures Manual and the Texas Medicaid Bulletins for more information. Although HMO is not responsible for paying or reimbursing for these noncapitated services, HMO remains responsible for providing appropriate referrals for Members to obtain or access these services.
Non-Capitated Services. 9.01 The Covered Medical Services encompassed in Non-Capitated Services are delineated in Exhibit A(1)
