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

• Furthermore, a study by Swissgrid concludes that the security of electricity supply is not endangered until 2025 (Swissgrid: 21 et seq.).

• 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.

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

• The Contractor’s request shall include: 6.3.3.2.1. The name of the hospital where the Member or Potential Member was an inpatient.

• If a Potential Member of the Contractor’s managed care initiative is an inpatient of a hospital at 11:59 p.m. the day before his/her enrollment is scheduled to take effect, enrollment shall be postponed until the first day of the month following discharge.

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 a person who meets the eligibility requirements to enroll in the Oregon Health Plan but has not yet enrolled with a specific CCO.