Provider Reimbursement. The HMO must make payment for all Medically Necessary Covered Services provided to all Members for whom the HMO is paid a capitation. A STAR+PLUS HMO must also make payment for all Functionally Necessary Covered Services provided to all Members for whom the HMO is paid a capitation. The HMO must ensure that claims payment is timely and accurate as described in Section 8.1.18.5. The HMO must require tax identification numbers from all participating Providers. The HMO is required to do back-up withholding from all payments to Providers who fail to give tax identification numbers or who give incorrect numbers.
Provider Reimbursement. The MCO must pay for all Medically Necessary Covered Services provided to Members. A STAR+PLUS MCO must also pay for all Functionally Necessary Covered Services provided to Members. The MCO's Network Provider Agreement must include a complete description of the payment methodology or amount, as described in Uniform Managed Care Manual Chapter 8.1.
Provider Reimbursement. The Department may define an alternative payment methodology to which Contractor must adhere to when reimbursing Providers for provided services.
Provider Reimbursement. The MCO must pay for all Medically Necessary Covered Services provided to all Members for whom the MCO is paid a capitation. A STAR+PLUS MCO must also pay for all Functionally Necessary Covered Services provided to all Members for whom the MCO is paid a capitation. The MCO must ensure that claims payment is timely and accurate as described in Section 8.1.18.5. The MCO must require tax identification numbers from all participating Providers. The MCO is required to do back-up withholding from all payments to Providers who fail to give tax identification numbers or who give incorrect numbers. Provider payments must comply with the requirements of Section 6505 of PPACA, entitled “Prohibition on Payments to Institutions or Entities Located Outside of the United States.” Provider payment must comply with the requirements of Section 2702 of PPACA, entitled “Payment Adjustment for Health Acquired Conditions.”
Provider Reimbursement. The MCO must pay for all Medically Necessary Covered Services provided to all Members for whom the MCO is paid a capitation. A STAR+PLUS MCO must also pay for all Functionally Necessary Covered Services provided to all Members for whom the MCO is paid a capitation. The MCO must ensure that claims payment is timely and accurate as described in Section 8.1.18.5. The MCO must require tax identification numbers from all participating Providers. The MCO is required to do back-up withholding from all payments to Providers who fail to give tax identification numbers or who give incorrect numbers. Provider payments must comply with all applicable state and federal laws, rules, and regulations, including the following sections of the Patient Protection and Affordable Care Act (PPACA) and, upon implementation, corresponding federal regulations: • Section 2702 of PPACA, entitled "Payment Adjustment for Health Care-Acquired Conditions;" • Section 6505 of PPACA, entitled "Prohibition on Payments to Institutions or Entities Located Outside of the United States;" and • Section 1202 of the Health Care and Education Reconciliation Act as amended by PPACA, entitled "Payments to Primary Care Physicians."
Provider Reimbursement. The HMO must make payment for all Medically Necessary Covered Services provided to all Members for whom the HMO is paid a capitation. A STAR+PLUS HMO must also make payment for all Functionally Necessary Covered Services provided to all Members for whom the HMO is paid a capitation. The HMO must ensure that claims payment is timely and accurate as described in Section 8.1.18.5. The HMO must require tax identification numbers from all participating Providers. The HMO is required to do back-up withholding from all payments to Providers who fail to give tax identification numbers or who give incorrect numbers. Provider Payments must comply with the requirements of Section 6505 of the Patient Protection and Affordable Care Act (P.L. 111-148), entitled "Prohibition on Payments to Institutions or Entities Located Outside of the United States." Provider payment must comply with the requirements of Section 2702 of PPACA, entitled “Payment Adjustment for Health Acquired Conditions.”
Provider Reimbursement. 10.1 Applicants who are approved for HPE may receive medical services from any registered AHCCCS provider.
Provider Reimbursement. 1. The SE shall be responsible for reimbursing network and non-network providers in accordance with the requirements of this Contract (see Article 3.18 and Article 6).
Provider Reimbursement. 1. For the term of this Contract, the Program Administrator, pursuant to its agreement with Governing Board, shall reimburse providers at rates determined by Governing Board. Governing Board shall establish a Provider Rates Policy that sets forth the basis for provider payment rates which is subject to revision from time to time as determined by Governing Board.
Provider Reimbursement. Although not in the Agreement, BCBS stated in its March 2008 Aware Pro- vider Service Agreement Renewal letter that there will be three changes relating to reimbursement: 1) BCBS will use of the 2008 Medicare Relative Value Units (RVUs) in place of using the 2007 Xxxx- sitional Fully Implemented RVUs; 2) Unlisted Injectable Drugs will be paid at 82% of AWP (Average Wholesale Price); and 3) BCBS will be applying a site of service differential payment starting July 1, 2009.
