PCCB definition
Examples of PCCB in a sentence
If the Health Plan provides services for which kick payments would have been paid under a capitated health plan contract, these payments will be added to the aggregate PCCB for reconciliation in the amounts and for the procedure codes listed in Attachment I for services for which claims are submitted.
The aggregate PCCB is used in the Agency’s cost reconciliation process to determine cost- savings and refunds due.
In performing the reconciliation process, the Agency will compare actual Medicaid payments for Health Plan covered services, paid for by the Agency on behalf of Health Plan enrollees, to the aggregate PCCB for the time period being reconciled.
If the actual Medicaid costs for Health Plan covered services provided to the Health Plan’s enrollees are greater than the aggregate PCCB, then cost savings have not occurred and the Health Plan may be required to refund a portion of the administrative allocation it received.
If the actual Medicaid costs for Health Plan covered services are less than the aggregate PCCB, then cost-savings have occurred, and the Health Plan may receive a share of those cost-savings.
The PCCB is calculated by the enrollees’ Medicaid eligibility groups (MEG).
Obstetrical deliveries and transplant services are kick payment services and as such are not included in the Reform PCCB.
For a Health Plan that receives a capitated payment for transportation for its Reform population, an adjustment will be made to the PCCB to account for the capitation payment received by the Health Plan from the Agency for transportation services.
However, the Agency shall use the enrollee’s age group at the time of each month’s Health Plan payment when establishing the PCCB.
For PSNs serving Reform populations, the PCCB is consistent with capitation rate methodology pursuant to s.