PAHP definition
Examples of PAHP in a sentence
A review by an MCO, PIHP, or PAHP of an adverse benefit determination, that is in accordance with 42 C.F.R. §438.400.
In accordance with 42 C.F.R. §438.400.,the processes the MCO, PIHP, or PAHP implements to handle appeals of an adverse benefit determination and grievances, as well as the processes to collect and track information about grievances and appeals.
Choice counseling does not include making recommendations for or against enrollment into a specific MCO, PIHP, or PAHP.
In accordance with 42 C.F.R. §438.2, any provider, group of providers, or entity that has a network provider agreement with a MCO, PIHP, or PAHP, or a subcontractor, and receives Medicaid funding directly or indirectly to order, refer or render covered services as a result of the state's contract with an MCO, PIHP, or PAHP.
Grievance includes an enrollee’s right to dispute an extension of time proposed by the MCO, PIHP or PAHP to make an authorization decision.
Potential Enrollee — A Medicaid beneficiary who is subject to mandatory enrollment or may voluntarily elect to enroll in a given MCO, PIHP, or PAHP, but is not yet an enrollee of a specific MCO, PIHP, or PAHP.
Risk Contract — A contract between the State, an MCO, PIHP, or PAHP under which the contractor: (1) Assumes risk for the cost of the services covered under the contract, and (2) Incurs loss if the cost of furnishing the services exceeds the payments under the contract.
Nonrisk Contract — A contract between the State and a PIHP or PAHP under which the contractor (1) Is not at financial risk for changes in utilization or for costs incurred under the contract that do not exceed the upper payment limits specified in 42 C.F.R. §447.362 and (2) May be reimbursed by the State at the end of the contract period on the basis of the incurred costs, subject to the specified limits.
A network provider is not a Subcontractor by virtue of the network Provider Agreement with the MCO, PIHP, or PAHP.
OTC — Over-the-Counter OUD-▇▇▇ — Opioid Use Disorder Centers of Excellence P&T — Pharmacy & Therapeutics PAHP — Prepaid Ambulatory Health Plan PARP — Prior Authorization Review Panel.