Capitated definition
Examples of Capitated in a sentence
Capitated PCPs, are also eligible to receive additional payments for meeting certain medical quality, patient service and other performance standards.
PPG Capitated Services and Shared Risk Services provided or arranged through PPG.
PPG shall compensate all providers who render PPG Capitated Services to Commercial HMO and Commercial POS Members assigned to PPG.
The Contractor must employ a qualified individual to serve as the contract manager of its Capitated Financial Alignment Model.
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.
Dual Eligible Members in Capitated Financial Alignment Demonstration Plans are not responsible for Cost Sharing Amounts for Medicare Parts A and B services.
A description of all Capitated Services provided through the Plan, in sufficient detail to enable the Participant or the Participant's representative, if appropriate, to understand the benefits available under the Plan.
An explanation of the procedure for obtaining Capitated Services, including any requirements for service authorizations and/or referrals for specialty care and for other benefits not furnished by the Participant’s PCP.
PPG and Member Physicians shall render Contracted Services which are not PPG Capitated Services to Members covered under this Addendum B and shall be compensated on a fee-for-service basis at the rates set forth in Addendum E.
PPG shall compensate all providers of PPG Capitated Services to Medicare HMO Members assigned to PPG.