Outlier definition

Outlier means a hospital claim or encounter in which the operating costs per day for an AHCCCS inpatient hospital stay meet the criteria described under this Article and A.R.S. § 36-2903.01(H).

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Outlier. ’ means a health care provider whose pattern of

Outlier means a hospital claim or encounter in which the Title XXI inpatient hospital days of care have operating costs per day that meet the criteria described in A.A.C. R9-22-712.

Examples of Outlier in a sentence

• The MCO shall retain responsibility for Care Management and prompt payment to providers for services provided to all potential Outlier Enrollees.

• The following formula shall be utilized to calculate the Outlier Allowable Fee: Outlier Allowable Fee = [billed charges – (MS-DRG Allowable Fee + Outlier Threshold)] x Marginal Factor.

• The STATE agrees to make payment to the MCO for seventy-five percent (75%) of allowable medical expenses in excess of one million dollars ($1,000,000) for Contract Year 2017 for Outlier Enrollees under this Contract, as described in this section.

• For Outlier cases, EGID shall base its payment to the Facility using an Outlier Allowable Fee plus the MS-DRG Allowable Fee.

• Additionally, Outlier Services must be accompanied by a DDSD RO Approval Form, and a MAD 046 or budget worksheet, with Outlier Services indicated as well as staff signature.

More Definitions of Outlier

Outlier means a discharge which has unique characteristics and is considered to be outside established parameters for each MS-DRG. A discharge is considered an Outlier if the billed charges exceed the sum of the Outlier Threshold plus the MS-DRG Allowable Fee.

Outlier means an observation that is well outside of the expected range of values in a study or experiment, and which is often discarded from the data set.

Outlier means a medicare case for which a federal intermediary has issued an additional payment beyond the applicable federal prospective payment rate as prescribed by the medicare program;

Outlier means a premises identified as having a lower than expected electricity consumption for the relevant property/customer type, as more particularly defined in the TRAS Contract.

Outlier means a hospital claim or encounter in which the AHCCCS inpatient hospital days of care have operating costs per day that meet the criteria described in R9-22-712. operating costs per day for an AHCCCS inpatient hospital stay meet the criteria described in R9-22-712.

Outlier means residents who have special care needs as defined under rule 5101:3-3-17 of the Administrative Code.

Outlier means a hospital claim or encounter in which the operating costs per day for an AHCCCS inpatient hospi- tal stay meet the criteria described under this Article and A.R.S. § 36-2903.01(H) 36-2903.01(G).