Supplemental Payments to PCPs Sample Clauses

Supplemental Payments to PCPs. Certain medical specialties (“Eligible Providers”) are to receive at the Medicare rate for certain services for calendar years 2013 and 2014. The capitation rates for this Contract do not reflect this payment. The Department shall provide to the Contractor: 1) the list of Eligible Providers who are eligible for reimbursement at Medicare payment levels; 2) the specific primary service codes that qualify for the ACA enhanced reimbursement; and 3) the payment rates for these codes. The Contractor shall file quarterly reports with the Department listing all professional claims in a format prescribed by the Department. The professional claims submitted shall be based on claims paid during the quarter with incurred dates during the Contract term. Contingent upon approval by CMS, the Department shall determine the additional amount to be paid and shall make supplemental payments to Contractor in that amount. The Department shall make all such supplemental payments to the Contractor within twenty (20) days of receipt of the quarterly report. The Contractor shall then distribute these payments to the Eligible Providers forty-five days after the end of the quarter. Submittals shall be submitted within fifteen days of the close of the quarter. The Contractor shall pass on the full benefit of the payment increase to Eligible Providers and shall provide a quarterly report of payments made to Eligible Providers that is in a form and format sufficient to satisfy the reporting requirements of CMS or other regulatory agencies when submitting the next subsequent quarterly report requesting payment. For claims paid after the Contract Term but incurred during the Contract term (i.e., run out claims) the Contractor shall continue to be responsible for processing the ACA enhanced reimbursement as contained herein. If the Contractor distributes the ACA enhanced reimbursement to a provider who was determined by the Department to be an Eligible Provider at the time of the payment, but who is subsequently determined to have been ineligible, the Contractor shall be held harmless in recouping such payment from the provider but shall reasonably cooperate with the Department in recouping such payment. 119
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