Directed Payment definition
Directed Payment means an Excess Payment that is:
Directed Payment means Provider payments as directed by HCA and approved by CMS in accordance with 42 C.F.R. § 438.6(c). Dual Eligible(s) means individuals who – by reason of age, income, and/or disability – qualify for Medicare and full Medicaid benefits under Section 1902(a)(10)(A) or 1902(a)(10)(C) of the Social Security Act, under Section 1902(f) of the Social Security Act or under any other category of eligibility (▇▇▇) for medical assistance for full benefits. Dual Eligible Special Needs Plans (D-SNP) means plans that enroll Members who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid. Durable Medical Equipment (DME) means equipment and supplies that are primarily used to serve a medical purpose, that are medically necessary to individuals with an illness, physical disability, or injury and that are commonly used at home. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) means the federally required Early and Periodic Screening, Diagnostic and Treatment program, as defined in Section 1905(r) of the Social Security Act and 42 C.F.R. § 441, Subpart B for Members under the age of twenty-one (21). It includes comprehensive periodic and inter-periodic screening and diagnostic services to determine Physical and Behavioral Health needs as well as the provision of all Electronic Clinical Data Systems (ECDS) are a NCQA network of HEDIS data containing a Member’s personal health information and records of their experiences within the health care system. Electronic Health Record (EHR) means a record in digital format that is a systematic collection of electronic health information. EHRs may contain a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, ▇▇▇▇▇ ▇▇▇▇▇, personal statistics such as age and weight, and billing information. Emergency Medical Condition means a Physical Health or Behavioral Health condition manifesting itself through acute symptoms of sufficient severity (including nerve pain) such that a prudent layperson with average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in: (i) placing the Member’s health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
Directed Payment means Provider payments as directed by HCA and approved by CMS in accordance with 42 C.F.R. § 438.6(c). Dual Eligible(s) means individuals who – by reason of age, income, and/or disability – qualify for Medicare and full Medicaid benefits under Section 1902(a)(10)(A) or 1902(a)(10)(C) of the Social Security Act, under Section 1902(f) of the Social Security Act or under any other category of eligibility (▇▇▇) for medical assistance for full benefits. Dual Eligible Special Needs Plans (D-SNP) means plans that enroll Members who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid. Durable Medical Equipment (DME) means equipment and supplies that are primarily used to serve a medical purpose, that are medically necessary to individuals with an illness, physical disability, or injury and that are commonly used at home. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) means the federally required Early and Periodic Screening, Diagnostic and Treatment program, as defined in Section 1905(r) of the Social Security Act and 42 C.F.R. § 441, Subpart B for Members under the age of twenty-one (21). It includes comprehensive periodic and inter-periodic screening and diagnostic services to determine Physical and Behavioral Health needs as well as the provision of all Medically Necessary Services listed in Section 1902(a) of the Social Security Act even if the service is not available under the State’s Medicaid State Plan. Electronic Clinical Data Systems (ECDS) are a NCQA network of HEDIS data containing a Member’s personal health information and records of their experiences within the health care system.
Examples of Directed Payment in a sentence
You do not have the right to cancel or amend any Directed Payment Instruction once given to us.
You acknowledge and agree that we may, in our sole and absolute discretion, reject any Directed Payment Instruction, including those which do not comply with the requirements of this Agreement, our internal policies, or applicable laws and regulations.
You agree to assume sole and absolute responsibility for any Directed Payment Instruction and such instructions may be relied upon by us, whether or not an error could be detected by us.
If the balance of your unused and available Advance is less than the amount of the Directed Payment Instruction, you may not use the Invoice Payment Dashboard to facilitate payment of the Directed Payment Instruction.
As of September 30, 2023, Florida has nine supplemental payment programs, including Low Income Pool, Disproportionate Share Hospital, Graduate Medical Education, Physician Supplemental Payment, Multi-Visceral Transplant Program, Florida Cancer Hospital Program, Public Emergency Medical Transportation, Indirect Medical Education, and the Directed Payment Program.
For purposes of this Signature Page, a Directed Payment Program (DPP) includes the following programs: Texas Incentives for Physician and Professional Services; Rural Access to Primary and Preventive Services; and Directed Payment Program for Behavioral Health Services.
You assume sole responsibility for any Directed Payment Instruction and such instructions may be relied upon by us, whether or not an error could be detected by us.
The DPP rates are identified in Exhibit 1, Directed Payment Program Rates.
You hereby acknowledge that the use of Directed Payment Instructions is also subject to terms set forth in the Invoice Payment Dashboard Services Agreement executed between you and us on or around the date hereof (the “IPDSA”).
Section 2.15.01.01 - Fee Schedule Increase, Adoption of Minimum/Maximum Fee Schedule and State Directed Payment Requirements is amended by DELETING the State Directed Payments table in its entirety and REPLACING with a new State Directed Payments table, as shown on the following page.
More Definitions of Directed Payment
Directed Payment means a payment to be made to the Offering Parties by the Stockholders in connection with a Substitute Acquisition, which payment shall be made (a) if possible, by the Stockholders directing the counterparty to, or paying agent for or with respect to, a Substitute Acquisition to make payments in the amounts required by this Agreement and consistent with the Payment Methodology to the Offering Parties upon the consummation of such Substitute Acquisition, or (b) if payment as contemplated by subsection (a) immediately above is not possible, by wire transfer made by the Stockholders to the Offering Parties in the amounts specified by this Agreement and consistent with the Payment Methodology, with such payments to be made concurrently with the Stockholders’ receipt of Gross Proceeds with respect to a Substitute Acquisition.
Directed Payment means Provider payments as directed by HCA and approved by CMS in accordance with 42 C.F.R. § 438.6(c). Dual Eligible(s) means individuals who – by reason of age, income, and/or disability – qualify for Medicare and full Medicaid benefits under Section 1902(a)(10)(A) or 1902(a)(10)(C) of the Social Security Act, under Section 1902(f) of the Social Security Act or under any other category of eligibility (▇▇▇) for medical assistance for full benefits. Dual Eligible Special Needs Plans (D-SNP) means plans that enroll Members who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid. Durable Medical Equipment (DME) means equipment and supplies that are primarily used to serve a medical purpose, that are medically necessary to individuals with an illness, physical disability, or injury and that are commonly used at home. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) means the federally required Early and Periodic Screening, Diagnostic and Treatment program, as defined in Section 1905(r) of the Social Security Act and 42 C.F.R. § 441, Subpart B for Members under the age of Electronic Clinical Data Systems (ECDS) are a NCQA network of HEDIS data containing a Member’s personal health information and records of their experiences within the health care system. Electronic Health Record (EHR) means a record in digital format that is a systematic collection of electronic health information. EHRs may contain a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, ▇▇▇▇▇ ▇▇▇▇▇, personal statistics such as age and weight, and billing information. Emergency Medical Condition means a Physical Health or Behavioral Health condition manifesting itself through acute symptoms of sufficient severity (including nerve pain) such that a prudent layperson with average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in: (i) placing the Member’s health (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
Directed Payment means payment arrangements under 42
Directed Payment means three hundred thousand dollars ($300,000).
Directed Payment means a payment arrangement authorized by CMS that permits the department to direct specific payments made by a managed care plan to providers.
Directed Payment means Provider payments as directed by HSD and approved by CMS in accordance with 42 C.F.R. § 438.6(c). Dual Eligible(s) means individuals who – by reason of age, income, and/or disability – qualify for Medicare and full Medicaid benefits under Section 1902(a)(10)(A) or 1902(a)(10)(C) of the Social Security Act, under Section 1902(f) of the Social Security Act or under any other category of eligibility (▇▇▇) for medical assistance for full benefits. Dual Eligible Special Needs Plans (D-SNP) means plans that enroll members who are entitled to both Medicare (Title XVIII) and Medical Assistance from a State Plan under Title XIX (Medicaid), and offer the opportunity of enhanced benefits by combining those available through Medicare and Medicaid. Durable Medical Equipment (DME) means equipment and supplies that are primarily used to serve a medical purpose, that are medically necessary to individuals with an illness, physical disability, or injury and that are commonly used at home. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) means the federally required Early and Periodic Screening, Diagnostic and Treatment program, as defined in Section 1905(r) of the Social Security Act and 42 C.F.R. § 441, Subpart B for Members under the age of twenty-one (21). It includes comprehensive periodic and inter-periodic screening and diagnostic services to determine Physical and Behavioral Health needs as well as the provision of all Medically Necessary Services listed in Section 1902(a) of the Social Security Act even if the service is not available under the State’s Medicaid State Plan.