Cost-Sharing Amounts definition
Cost-Sharing Amounts means any amounts payable by a Covered Person, such as copayments, cost-sharing, coinsurance, deductibles or other amounts that are the Covered Person’s financial responsibility under the applicable Coverage Agreement, if applicable. This compensation schedule (“Compensation Schedule”) sets forth the maximum reimbursement amounts for Covered Services provided by Contracted Providers to Covered Persons enrolled in a Medicaid Product. Where the Contracted Provider’s tax identification number (“TIN”) has been designated by the Payor as subject to this Compensation Schedule, Payor shall pay or arrange for payment of a Clean Claim for Covered Services rendered by the Contracted Provider according to the terms of, and subject to the requirements set forth in, the Agreement and this Compensation Schedule. Payment under this Compensation Schedule shall consist of the Allowed Amount as set forth herein less all applicable Cost-Sharing Amounts. All capitalized terms used in this Compensation Schedule shall have the meanings set forth in the Agreement, the applicable Product Attachment, or the Definitions section set forth at the end of this Compensation Schedule. The maximum compensation for home infusion Covered Services rendered to a Covered Person shall be the “Allowed Amount.” Except as otherwise provided in this Compensation Schedule, the Allowed Amount for home infusion Covered Services is the lesser of: (i) Allowable Charges; or (ii) one hundred percent (100%) (such percentage, the “Fee Percentage”) of the amount payable based on the Medicaid fee schedule set forth by the North Carolina Division of Health Benefits (“NCDHB”) at the date of service. It is hereby acknowledged and agreed that the NCDHB, a division of the North Carolina Department of Health and Human Services, has filed a waiver with the Centers for Medicare and Medicaid Services to privatize the North Carolina Medicaid Program, with issuance of a request for proposal (“RFP”) currently projected in 2018, RFP awards (“RFP Awards”) currently projected in 2018, and an implementation date (“Implementation Date”) currently projected in 2019. Health Plan intends to submit a proposal under the RFP process. As of the date of this Agreement, the NCDHB has not, publicly announced or otherwise made available to the Health Plan the premiums under the Health Plan (the “Premiums”), or the actuarial studies, utilization data, unit cost data or other actuarial assumptions made (collectively, the “State Actuarial ...
Cost-Sharing Amounts means any amounts payable by a Covered Person, such as copayments, cost-sharing, coinsurance, deductibles or other amounts that are the Covered Person’s financial responsibility under the applicable Coverage Agreement, if applicable.
Cost-Sharing Amounts means those coinsurance, copays, or other cost sharing amounts which may be collected by Administrator from a Member for Covered Prescription Services in accordance with the terms and conditions of the Member’s Benefit Plan.
Examples of Cost-Sharing Amounts in a sentence
Any Cost-Sharing Amounts that the Covered Person is responsible to pay under the Coverage Agreement will be subtracted from the Allowed Amount in determining the amount to be paid.
More Definitions of Cost-Sharing Amounts
Cost-Sharing Amounts means any amounts payable by a Covered Person, such as copayments, cost-sharing, coinsurance, deductibles or other amounts that are the Covered Person’s financial responsibility under the applicable Coverage Agreement, if applicable. Attachment A: Medicaid EXHIBIT 7 COMPENSATION SCHEDULE ANCILLARY SERVICES URGENT CARE This compensation schedule (“Compensation Schedule”) sets forth the maximum reimbursement amounts for Covered Services provided by Contracted Providers to Covered Persons enrolled in a Medicaid Product. Where the Contracted Provider’s tax identification number (“TIN”) has been designated by the Payor as subject to this Compensation Schedule, Payor shall pay or arrange for payment of a Clean Claim for Covered Services rendered by the Contracted Provider according to the terms of, and subject to the requirements set forth in, the Agreement and this Compensation Schedule. Payment under this Compensation Schedule shall consist of the Allowed Amount as set forth herein less all applicable Cost-Sharing Amounts. All capitalized terms used in this Compensation Schedule shall have the meanings set forth in the Agreement, the applicable Product Attachment, or the Definitions section set forth at the end of this Compensation Schedule. The maximum compensation for urgent care Covered Services rendered to a Covered Person shall be the “Allowed Amount.” Except as otherwise provided in this Compensation Schedule, the Allowed Amount for urgent care Covered Services is the lesser of: (i) Allowable Charges; or (ii) one hundred percent (100%) (such percentage, the “Fee Percentage”) of the amount payable based on the Medicaid fee schedule set forth by the North Carolina Division of Health Benefits (“NCDHB”) at the date of service. It is hereby acknowledged and agreed that the NCDHB, a division of the North Carolina Department of Health and Human Services, has filed a waiver with the Centers for Medicare and Medicaid Services to privatize the North Carolina Medicaid Program, with issuance of a request for proposal (“RFP”) currently projected in 2018, RFP awards (“RFP Awards”) currently projected in 2018, and an implementation date (“Implementation Date”) currently projected in 2019. Health Plan intends to submit a proposal under the RFP process. As of the date of this Agreement, the NCDHB has not, publicly announced or otherwise made available to the Health Plan the premiums under the Health Plan (the “Premiums”), or the actuarial studies, utilization data, unit ...
Cost-Sharing Amounts means the amounts that an insured is responsible for under a preferred provider insurance policy, including any deductibles, coinsurance, or copayments.
Cost-Sharing Amounts means the portion of the cost of a Covered Expense for a benefit that a Participant is responsible for paying out-of-pocket.
Cost-Sharing Amounts means any amounts payable by a Covered Person, such as copayments, cost-sharing, coinsurance, deductibles or other amounts that are the Covered Person’s financial responsibility under the applicable Coverage Agreement, if applicable. This compensation schedule (“Compensation Schedule”) sets forth the maximum reimbursement amounts for Covered Services provided by Contracted Providers to Covered Persons enrolled in a Medicaid Product. Where the Contracted Provider’s tax identification number (“TIN”) has been designated by the Payor as subject to this Compensation Schedule, Payor shall pay or arrange for payment of a Clean Claim for Covered Services rendered by the Contracted Provider according to the terms of, and subject to the requirements set forth in, the Agreement and this Compensation Schedule. Payment under this Compensation Schedule shall consist of the Allowed Amount as set forth herein less all applicable Cost-Sharing Amounts. All capitalized terms used in this Compensation Schedule shall have the meanings set forth in the Agreement, the applicable Product Attachment, or the Definitions section set forth at the end of this Compensation Schedule.
Cost-Sharing Amounts means any amounts payable by a Covered Person, such as copayments, cost-sharing, coinsurance, deductibles or other amounts that are the Covered Person’s financial responsibility under the applicable Coverage Agreement, if applicable. This compensation schedule (“Compensation Schedule”) sets forth the maximum reimbursement amounts for Covered Services provided by Contracted Providers to Covered Persons enrolled in a Medicaid Product. Where the Contracted Provider’s tax identification number (“TIN”) has been designated by the Payor as subject to this Compensation Schedule, Payor shall pay or arrange for payment of a Clean Claim for Covered Services rendered by the Contracted Provider according to the terms of, and subject to the requirements set forth in, the Agreement and this Compensation Schedule. Payment under this Compensation Schedule shall consist of the Allowed Amount as set forth herein less all applicable Cost- Sharing Amounts. All capitalized terms used in this Compensation Schedule shall have the meanings set forth in the Agreement, the applicable Product Attachment, or the Definitions section set forth at the end of this Compensation Schedule. The maximum compensation for ambulatory surgery center Covered Services rendered to a Covered Person shall be the “Allowed Amount.” Except as otherwise provided in this Compensation Schedule, the Allowed Amount for ambulatory surgery center Covered Services is the lesser of: (i) Allowable Charges; or (ii) one hundred percent (100%) of the Payor’s Medicaid fee schedule.
Cost-Sharing Amounts means any amounts payable by a Covered Person, such as copayments, cost-sharing, coinsurance, deductibles or other amounts that are the Covered Person’s financial responsibility under the applicable Coverage Agreement, if applicable. EXHIBIT A HBR INCENTIVE PROGRAM For purposes of this HBR Incentive Program Exhibit (this “Exhibit”), shall be referred to as “Provider”. This Exhibit shall be effective as of the first day of the first calendar quarter following the effective date of the Agreement (the “Exhibit Effective Date”). This HBR Incentive Program has been established for the purpose of sharing financial savings with providers who achieve an overall reduction in medical costs for the Covered Persons assigned to them. Specifically, Provider shall be eligible for an incentive payment hereunder (an “HBR Incentive”) based on medical cost reductions that are achieved by health care professionals whom Provider employs or contracts (“Professionals”), as set forth herein. The Parties to this Exhibit agree and acknowledge that compensation paid to Provider under this HBR Incentive Program is not intended to and does not provide incentives to Provider or the Professionals to deny, limit, reduce or discontinue Covered Services to any Covered Person.
Cost-Sharing Amounts means any amounts payable by a Covered Person, such as copayments, cost-sharing, coinsurance, deductibles or other amounts that are the Covered Person’s financial responsibility under the applicable Coverage Agreement, if applicable. EXHIBIT 3 COMPENSATION SCHEDULE CRITICAL ACCESS HOSPITAL SERVICES Mangum City Hospital Authority dba ▇▇▇▇▇▇ Regional Medical Center and ▇▇▇▇▇▇ Family Clinic This compensation schedule (“Compensation Schedule”) sets forth the maximum reimbursement amounts for Covered Services provided by Contracted Providers to Covered Persons enrolled in a Medicaid Product. Where the Contracted Provider’s tax identification number (“TIN”) has been designated by the Payor as subject to this Compensation Schedule, Payor shall pay or arrange for payment of a Clean Claim for Covered Services rendered by the Contracted Provider according to the terms of, and subject to the requirements set forth in, the Agreement and this Compensation Schedule. Payment under this Compensation Schedule shall consist of the Allowed Amount as set forth herein less all applicable Cost-Sharing Amounts. All capitalized terms used in this Compensation Schedule shall have the meanings set forth in the Agreement, the applicable Product Attachment, or the Definitions section set forth at the end of this Compensation Schedule. Inpatient Services. The maximum compensation for Covered Services rendered to a Covered Person during an inpatient stay shall be the “Allowed Amount” as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for inpatient Covered Services is the lesser of: (i) Allowable Charges; or (ii) 100% of the Medicaid fee schedule. Such payment shall be inclusive of all services rendered. Outpatient Services. The maximum compensation for outpatient Covered Services is the “Allowed Amount” as set forth below. Except as otherwise provided in this Compensation Schedule, the Allowed Amount for outpatient Covered Services is the lesser of (i) Allowable Charges; or (ii) 100% of the Medicaid fee schedule. Such payment shall be inclusive of all services rendered.