Common use of Capitation Payments Clause in Contracts

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. 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); anddies);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. If Provider is compensated via a capitation arrangement, Provider must: (a) Immediately notify Subcontractor or Health Plan, as applicable, and the Division Bureau 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 Bureau of TennCare that meets the same standards of completeness and accuracy as required for proper adjudication of fee-for-service claims.