Potential Member definition

Potential Member means an individual who meets the eligibility requirements to enroll in the Oregon Health Plan but has not yet enrolled with a specific PHP or CCO.
Potential Member means a person who meets the eligibility requirements to enroll in the Oregon Health Plan but has not yet enrolled with a specific PHP.
Potential Member means an individual who meets the eligibility requirements to enroll in the Oregon Health Plan but has not yet enrolled with a specific MCE.

Examples of Potential Member in a sentence

  • In the event that a Potential Member who has escrow funds in the Subscription Account is not admitted into the Company, upon Written Instructions, the Escrow Agent shall promptly issue refunds to the Potential Member in the amount of the principal balance with accrued interest.

  • All deposits to the Accounts shall be subject to the Escrow Agent's receipt of a valid tax identification number for the Company, Manager or Potential Member, as applicable.

  • The Contractor's request shall include the name of the hospital where the Member or Potential Member was inpatient and the date of admission.

  • Potential Member – an individual enrolled in Medicaid who is eligible for the Contractor’s managed care capitation initiative but is not yet enrolled.

  • Cold-Call Marketing – any unsolicited personal contact by the MCO with a Potential Member for the purposes of marketing as defined at 42 CFR 438.104.


More Definitions of Potential Member

Potential Member means, as defined in OAR 410-141-3500, a person who meets the eligibility requirements to enroll in the Oregon Health Plan but has not yet enrolled with a specific MCE;
Potential Member. A Medicaid or SCHIP recipient who is subject to mandatory Enrollment in a care management program but is not yet the Member of a specific CMO plan. Pre-Certification: Review conducted prior to a Member’s admission, stay or other service or course of treatment in a hospital or other facility.
Potential Member means a person who meets the eligibility requirements to enroll in the Oregon Health Plan but has not yet enrolled with a specific CCO.
Potential Member means a person who –
Potential Member means an OHP client who meets the requirements set forth in ORS 414.631 to be in a coordinated care organization.
Potential Member means a person who does need the core services being offered by a cooperative, may be accessing them, and is eligible to be a member of that cooperative, but who has not yet applied for membership and/or been admitted as a member ;
Potential Member. A BadgerCare Plus or SSI member who is subject to mandatory managed care enrollment or may voluntarily elect to enroll in a given managed care program, but is not yet a member of a specific HMO. Potentially Preventable Readmissions (PPR) initiative: DHS initiative requiring HMOs to collaborate with their providers to reduce preventable hospital readmissions within 30 days of discharge from inpatient care.