Common use of Adjusted Service Expenditures Clause in Contracts

Adjusted Service Expenditures. The Contractor’s Actual Service Expenditures, adjusted to reflect the following: - Exclusion of the net cost of all services provided under Medicare Part D; - Reductions to reflect any recoveries from other payors outside of claims adjudication, including those pursuant to coordination of benefits, third party liability, rebates, supplemental payments, adjustments in claims paid, adjustments from providers including adjustments to claims paid, and Enrollee contributions to care. These adjustments shall exclude any adjustments associated with coverage of Medicare Part D services; and - Adjustments resulting from CMS and the state review of Contractor reimbursement methodologies and levels to address any excessive pricing.

Adjusted Service Expenditures. The Contractor’s Actual Service Expenditures, adjusted to reflect the following: - Exclusion of the net cost of all services provided under Medicare Part D; - Reductions to reflect any recoveries from other payors outside of claims adjudication, including those pursuant to coordination of benefits, third party liability, rebates, supplemental payments, adjustments in claims paid, adjustments from providers including adjustments to claims paid, and Enrollee contributions to care. These adjustments shall exclude any adjustments associated with coverage of Medicare Part D services; and - Adjustments resulting from CMS and the state State review of Contractor reimbursement methodologies and levels to address any excessive pricing.