Capitation Payments Sample Clauses

Capitation Payments. The MCO must refer to Attachment A, “Uniform Managed Care Contract Terms and Conditions” for information and Contract requirements on the: 1. time and Manner of Payment, 2. adjustments to Capitation Payments,

Capitation Payments. Capitation payments by a Contractor to a Primary Care Provider or clinic contracting with the Contractor on a capitation basis shall be payable effective the date of the Member’s enrollment where the Member’s assignment to or selection of a Primary Care Provider or clinic has been confirmed by the Contractor. However, capitation payments by a Contractor to a Primary Care Provider or clinic for a Member whose assignment to or selection of a Primary Care Provider or clinic was not confirmed by the Contractor on the date of the beneficiary’s enrollment, but is later confirmed by the Contractor, shall be payable no later than 30 calendar days after the Member’s enrollment.

Capitation Payments. Compensation to the Contractor shall consist of a monthly capitation payment for each Enrollee and the Supplemental Capitation Payments as described in Sections 3.1 (c) and 3.1 (d), where applicable. a) In no event shall monthly capitation payments to the Contractor for the Benefit Package exceed the cost of providing the Benefit Package on a fee-for-service basis to an actuarially equivalent, non-enrolled population group Upper Payment Limit (UPL) as determined by SDOH. b) The monthly Capitation Rates are attached hereto as Appendix L and shall be deemed incorporated into this Agreement without further action by the parties. c) The monthly capitation payments and the Supplemental Newborn Capitation Payment and the Supplemental Maternity Capitation Payment to the Contractor shall constitute full and complete payments to the Contractor for all services that the Contractor provides pursuant to this Agreement subject to stop-loss provisions set forth in Section 3.11 and 3.12 of this Agreement. d) Capitation Rates shall be effective for the entire contract period, except as described in Section 3.2.

Capitation Payments. (a) Blue Shield shall pay Group, on a monthly basis, the applicable Capitation set forth in Exhibit C. Such Capitation shall be paid for Members not enrolled in the Blue Shield 65 Plus Benefit Program no later than the twentieth (20th) day of the month. Capitation shall be paid for Members who are enrolled in Blue Shield’s Blue Shield 65 Plus Benefit Program no later than the later occurring of the twentieth (20th) day of the month or five (5) business days following the date Blue Shield receives the CMS capitation payment for such Members.

Capitation Payments. PacifiCare shall make monthly Capitation Payments to Medical Group as payment for providing and arranging Covered Services to Medical Group Members for each Managed Care Plan, as specified in this Agreement and the applicable Product Attachment.

Capitation Payments. If Provider is compensated via a capitation arrangement, Provider must: (a) Immediately notify Subcontractor or Health Plan, as applicable, and the Division of TennCare by certified mail, return receipt requested, if Provider becomes aware for any reason that he or she is not entitled to capitation payment for a particular Covered Person (for example, if an Covered Person dies); and (b) Submit utilization or encounter data as specified by Subcontractor and Health Plan so as to ensure Health Plan’s ability to submit encounter data to the Division of TennCare that meets the same standards of completeness and accuracy as required for proper adjudication of fee-for-service claims.

Capitation Payments. The HMO must refer to the HHSC Uniform Managed Care Contract Terms & Conditions for information and Contract requirements on the: 1) Time and Manner of Payment, 2) Adjustments to Capitation Payments, 3) Delivery Supplemental Payment, and 4) Experience Rebate.

Capitation Payments. The STATE will pay to the MCO a Capitation Payment for each Enrollee in accordance with Article 4 for the month in which coverage becomes effective and thereafter until termination of Enrollee coverage pursuant to section 3.4 becomes effective.

Capitation Payments. 7.3.1.1. The Department agrees to make, and the CONTRACTOR agrees to accept the Capitation Payments, as outlined in Appendix B, and any other authorized payments, as payment in full for all services provided to Medicaid Managed Care Members pursuant to this contract. 7.3.1.2. The Department will perform Managed Care Capitation Payment certifications that will require the CONTRACTOR to provide reports detailed in the Managed Care Policy and Procedure Guide and Managed Care Report Companion Guide. 7.3.1.3. The Capitation Payment is equal to the monthly number of Medicaid Managed Care Members in each category multiplied by the capitation rate established for each category per month plus a maternity kicker payment for each Medicaid Managed Care Member who delivers during the month. 7.3.1.4. To the extent there are material changes, as determined by the Department, to the Medicare fee schedule and subsequent changes to the Medicaid fee schedule during the contract period, the Department reserves the right to adjust the Capitation Payments accordingly. 7.3.1.5. No more frequently than once during each Department fiscal year (a.k.a. state fiscal year (SFY); July 1st to June 30th), the Department reserves the right to defer remittance of the Capitation Payment to the CONTRACTOR. 7.3.1.5.1. The Department will notify CONTRACTOR of such deferral at least fourteen (14) Business Days prior to the expected payment date. 7.3.1.5.2. The Department may defer the Capitation Payment for a period not longer than thirty-three (33) Calendar Days from the original payment date to comply with the Department’s fiscal Policies and Procedures. 7.3.1.6. In the event the federal government lifts any moratorium on supplemental payments to Physicians or facilities, capitation rates in this contract will be adjusted accordingly.

Capitation Payments. If Provider is compensated via a capitation arrangement, Provider must: i) Immediately notify United and the Division of TennCare by certified mail, return receipt requested, if Provider becomes aware for any reason that he or she is not entitled to capitation payment for a particular Covered Person (for example, if an Covered Person dies); and ii) Submit utilization or encounter data as specified by United so as to ensure United’s ability to submit encounter data to the Division of TennCare that meets the same standards of completeness and accuracy as required for proper adjudication of fee-for-service claims.