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

• Member or Enrollee: a Potential Member who has enrolled with CenCal Health.

• Potential Member or Potential Enrollee: a Medi-Cal recipient who resides inCenCal Health’s service area and is subject to mandatory enrollment, or who may voluntarily elect to enroll, but is not yet enrolled, in a Medi-Cal managed care health plan, and is in one of the aid codes specified by DHCS.

• The Division shall not encourage or induce a Member to select a particular AdSS when completing the application and may not complete any portion of the application on behalf of the Potential Member.

• Member or Enrollee: a Potential Member who has enrolled with CenCal Health.Potential Member or Potential Enrollee: a Medi-Cal recipient who resides in CenCal Health’s service area and is subject to mandatory enrollment, or who may voluntarily elect to enroll, but is not yet enrolled, in a Medi-Cal managed care health plan, and is in one of the aid codes specified by DHCS.

• Complete any portion of the application on behalf of the Potential Member, this prohibition covers all situations, whether sponsored by the AdSS, their parent company, or any other entity.

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 –

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.

Potential Member means an individual who meets the eligibility requirements to enroll in the