Outpatient Hospital Services Provided by Primary Provider Network Sample Clauses

Outpatient Hospital Services Provided by Primary Provider Network. Provider claims submitted will be priced and paid to providers according to the approved Medicaid reimbursement methodology as of November 30, 2009 with the following exceptions. The differences between the methodology to price IowaCare claims versus Medicaid state plan claims are the level of the APC base rate and the fee schedule amounts. As of December 1, 2009, the Medicaid state plan APC base rates for both Broadlawns and UIHC were reduced by five percent to implement the Governor’s Executive Order 19. This rate reduction was not applied to the APC base rate for IowaCare services. In addition, effective July 1, 2010, a rate increase will be applied to Broadlawns’ and UIHC’s APC base rates for Medicaid state plan services, however this rate increase will not be provided to Broadlawns’ APC base rate for IowaCare services. Effective January 1, 2012, APC base rates will be updated to reflect the triennial outpatient hospital rebase process. Two separate APC base rates will be calculated for Broadlawns Medical Center: a) APC base rate that includes the hospital health care assessment inflation factor and b) APC base rate that does not include the hospital health care assessment inflation factor. The APC base rate that includes the hospital health care assessment inflation factor will be used for Medicaid state plan services; however the APC base rate that excludes the hospital health care assessment inflation factor will be used for IowaCare services. Only one APC base rate will be calculated for UIHC. This APC base rate, which does not include the hospital health care assessment inflation factor will be used for both Medicaid state plan services and IowaCare services. Any fee schedule amounts shall be the agency’s rates set as of July 1, 2008, except for preventative exam codes in which the fee schedule amounts shall be the agency’s rates set as of July 1, 2010. Payments to UIHC, as indicated in the STCs must be reconciled with the applicable cost-based UPL annually.
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Related to Outpatient Hospital Services Provided by Primary Provider Network

  • Provider Network The Panel of health service Providers with which the Contractor contracts for the provision of covered services to Members and Out-of-network Providers administering services to Members.

  • Outpatient If you receive dialysis services in a hospital's outpatient unit or in a dialysis facility, we cover the use of the treatment room, related supplies, solutions, drugs, and the use of the dialysis machine. In Your Home If you receive dialysis services in your home and the services are under the supervision of a hospital or outpatient facility dialysis program, we cover the purchase or rental (whichever is less, but never to exceed our allowance for purchase) of the dialysis machine, related supplies, solutions, drugs, and necessary installation costs. Related Exclusions If you receive dialysis services in your home, this agreement does NOT cover: • installing or modifying of electric power, water and sanitary disposal or charges for these services; • moving expenses for relocating the machine; • installation expenses not necessary to operate the machine; or • training you or members of your family in the operation of the machine. This agreement does NOT cover dialysis services when received in a doctor’s office.

  • Provider Services The Contractor’s system shall collect, process, and maintain current and historical data on program providers. This information shall be accessible to all parts of the MCMIS for editing and reporting.

  • Outpatient Services The following services are covered only at the Primary Care Provider’s office[selected by a [Member], or elsewhere [upon prior written Referral by a [Member]'s Primary Care Provider ]:

  • DEPENDENT PERSONAL SERVICES 1. Subject to the provisions of Articles 16, 18, 19, 20 and 21, salaries, wages and other similar remuneration derived by a resident of a Contracting State in respect of an employment shall be taxable only in that State unless the employment is exercised in the other Contracting State. If the employment is so exercised, such remuneration as is derived therefrom may be taxed in that other State.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Restricted Use By Outsourcers / Facilities Management, Service Bureaus or Other Third Parties Outsourcers, facilities management or service bureaus retained by Licensee shall have the right to use the Product to maintain Licensee’s business operations, including data processing, for the time period that they are engaged in such activities, provided that: 1) Licensee gives notice to Contractor of such party, site of intended use of the Product, and means of access; and 2) such party has executed, or agrees to execute, the Product manufacturer’s standard nondisclosure or restricted use agreement which executed agreement shall be accepted by the Contractor (“Non-Disclosure Agreement”); and 3) if such party is engaged in the business of facility management, outsourcing, service bureau or other services, such third party will maintain a logical or physical partition within its computer system so as to restrict use and access to the program to that portion solely dedicated to beneficial use for Licensee. In no event shall Licensee assume any liability for third party’s compliance with the terms of the Non-Disclosure Agreement, nor shall the Non-Disclosure Agreement create or impose any liabilities on the State or Licensee. Any third party with whom a Licensee has a relationship for a state function or business operation, shall have the temporary right to use Product (e.g., JAVA Applets), provided that such use shall be limited to the time period during which the third party is using the Product for the function or business activity.

  • Hospital Services The Hospital will:

  • Outpatient emergency and urgicenter services within the service area The emergency room copay applies to all outpatient emergency visits that do not result in hospital admission within twenty-four (24) hours. The urgicenter copay is the same as the primary care clinic office visit copay.

  • Inpatient Services Hospital This plan covers services provided while inpatient in a general or specialty hospital including, but not limited to the following: • anesthesia; • diagnostic tests and lab services; • dialysis; • drugs; • intensive care/coronary care; • nursing care; • physical, occupational, speech and respiratory therapies; • physician’s services while hospitalized; • radiation therapy; • surgery related services; and • room and board. Notify us if you are admitted from the emergency room to a hospital that is not in our network. Our Customer Service Department can assist you with any questions you may have about your coverage. Rehabilitation Facility This plan covers rehabilitation services received in a general hospital or specialty hospital. Coverage is limited to the number of days shown in the Summary of Medical Benefits.

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