Medicare enrollee definition

Medicare enrollee means a Medicare beneficiary who is enrolled in a PACE program.
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Medicare enrollee means an Enrollee in any of Plan’s Medicare Advantage products.
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Medicare enrollee means an Individual who is enrolled in Company’s Medicare Product on either a Group or Individual enrollment basis according to CMS’s records and for whom CMS has paid Company the applicable monthly payment amount.
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Examples of Medicare enrollee in a sentence

  • Each Medicare enrollee by mail at least 90 calendar days before the date on which the nonrenewal is effec- tive.

  • An MA organization that offers an MA co- ordinated care plan may specify the networks of providers from whom en- rollees may obtain services if the MA organization ensures that all covered services, including supplemental serv- ices contracted for by (or on behalf of) the Medicare enrollee, are available and accessible under the plan.

  • In the absence of intention it must be established that the alleged offender had knowledge that the publication was likely to defame the person.

  • An MA organization may bill a GHP or LGHP for services it fur- nishes to a Medicare enrollee who is also covered under the GHP or LGHP and may bill the Medicare enrollee to the extent that he or she has been paid by the GHP or LGHP.

  • Agreement by a provider to accept capitation payment for each Medicare enrollee.

  • The Medicare enrollee, to the ex- tent that he or she has been paid by the carrier, employer, or entity for covered medical expenses.

  • CMS con- ducts this reconciliation as necessary to ensure that the payments made do not exceed or fall short of the appro- priate per capita rate of payment for each Medicare enrollee of the HMO or CMP during the contract period.

  • The HMO or CMP promptly noti- fies the beneficiary of the effective month of his or her enrollment as a Medicare enrollee, when it receives that information from CMS.

  • Federal regulations state that MA organizations must follow CMS’s instructions and submit to CMS the data necessary to characterize the context and purposes of each service provided to a Medicare enrollee by a provider, supplier, physician, or other practitioner (42 CFR§ 422.310(b)).

  • Each MA organization must submit to CMS (in accordance with CMS instructions) the data necessary to characterize the context and purposes of each item and service provided to a Medicare enrollee by a provider, supplier, physician, or other practitioner.

Related to Medicare enrollee

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • Medicaid means the medical assistance programs administered by state agencies and approved by CMS pursuant to the terms of Title XIX of the Social Security Act, codified at 42 U.S.C. 1396 et seq.

  • Medicare Provider Agreement means an agreement entered into between CMS or other such entity administering the Medicare program on behalf of CMS, and a health care provider or supplier under which the health care provider or supplier agrees to provide items and services for Medicare patients in accordance with the terms of the agreement and Medicare Regulations.

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

  • Medicare Advantage The Medicare managed care options that are authorized under Title XVIII as specified at Part C and 42 C.F.R. § 422.

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Enrollee means any person entitled to health care services from a carrier.

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).

  • TRICARE means, collectively, a program of medical benefits covering former and active members of the uniformed services and certain of their dependents, financed and administered by the United States Departments of Defense, Health and Human Services and Transportation, and all laws applicable to such programs.

  • Health care entity means any health care provider, health plan or health care clearinghouse.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other such entity administering the Medicaid program and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Health care system means any public or private entity whose function or purpose is the management of, processing of, enrollment of individuals for or payment for, in full or in part, health care services or health care data or health care information for its participants;

  • Health Care Law means any Applicable Law regulating the acquisition, construction, operation, maintenance or management of a healthcare practice, facility, provider or payor.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Managed care plan means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use health care providers managed, owned, under contract with or employed by the health carrier.

  • Health care plan means any contract, policy or other arrangement for benefits or services for medical or dental care or treatment under:

  • Newborn means a baby less than nine days old.

  • Health care practitioner means an individual licensed

  • Health care coverage means any plan providing hospital, medical or surgical care coverage for

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

  • Health care organization ’ means any person or en-

  • Adult care home means any nursing facility, nursing facility for

  • Managed care entity means either a managed care organization licensed by the department of insurance (e.g., HMO or PHP) or a primary care case management program (i.e., MediPASS).