Managed care health plan definition

Managed care health plan means an individual, organization, or entity that enters into a contract with the department pursuant to Article 2.7 (commencing with Section 14087.3), Article 2.81 (commencing with Section 14087.96), Article 2.91 (commencing with Section 14089), or Chapter 8 (commencing with Section 14200).

Managed care health plan means a health benefit plan that selects and contracts with health care providers; manages and coordinates health care delivery; monitors necessity, appropriateness, and quality of health care delivered by health care providers; and performs utilization review and cost control.

Managed care health plan means a health

Examples of Managed care health plan in a sentence

• Managed care health plan enrollment can be verified by the IVR/Internet.Providers must verify the eligibility status including the participant's ME code and managed care health plan enrollment status on all MO HealthNet participants before providing service.The following information is provided to assist providers in determining those participants who are eligible for inclusion in MO HealthNet Managed Care Programs.

• Managed care health plan performance measures may include measures from HEDIS; measures indicative of performance in serving special needs populations, such as the NCQA Structure and Process measures; or both.

• If a party did not timely file suit in keeping with a statute of limitations, the party cannot make the claim.

• Managed care health plan enrollment process for both new enrollee and transition populations.‌ Populations Impacted by SB 75‌‌There are two populations of children impacted by this change in Medi-Cal coverage. New Enrollee Population: Individuals under the age of 19 who meet all eligibility requirements for SB 75 but are not enrolled in the Medi-Cal program at the implementation of SB 75.

• Managed care health plan design, premium development and/or risk adjustment, provider network adequacy, Medicare Advantage and Medicare Supplemental benefits, health care data analysis, and/or population health risk assessment.

More Definitions of Managed care health plan

Managed care health plan means an individual,

Managed care health plan means an individual, organization, or entity that enters into a contract with the department pursuant to Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing with Section 14087.5), Article 2.81 (commencing with Section 14087.96), or Article 2.91 (commencing with Section 14089), of this chapter, or Chapter 8 (commencing with Section 14200). For the purposes of this article, “managed care health plan” shall not include an individual, organization, or entity that enters into a contract with the department to provide services pursuant to Chapter 8.75 (commencing with Section 14591) or the Senior Care Action Network.

Managed care health plan means a health care plan offered by a managed care organization that provides for the delivery of comprehensive basic health care services and medically necessary services to individuals enrolled in the plan other than those services provided to medicare patients pursuant to Title 18 of the federal Social Security Act or to medicaid patients pursuant to Title 19 or Title 21 of the federal Social Security Act;

Managed care health plan means a Medi-Cal managed care plan contracting with the department under this chapter or Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing with Section 14087.5), Article 2.81 (commencing with Section 14087.96), or Article 2.91 (commencing with Section 14089) of Chapter 7.

Managed care health plan means a Medi-Cal managed

Managed care health plan means an individual, organization, or entity that enters into a contract with the department pursuant to Article 2.7 (commencing with Section 14087.3), Article 2.8 (commencing with Section 14087.5), Article

Managed care health plan means an individual, organization, or entity that enters into a contract with the department pursuant to Article 2.7 (commencing with Section