Contractor Provider Payments. If a Contractor includes a Physician Incentive Plan, the activities included shall comply with requirements set forth in 42 CFR 422.208 and 42 CFR 422.210. The Disclosures to the Department for Contractors with Physician Incentive Plans include the following: A. The Contractor shall report whether services not furnished by a physician/group are covered by the incentive plan. No further disclosure is required if the Physician Incentive Payment does not cover services not furnished by a physician/group. B. The Contractor shall report type of incentive arrangement, e.g. withhold, bonus, capitation. C. The Contractor shall report percent of withhold or bonus (if applicable). D. The Contractor shall report panel size, and if patients are pooled, the approved method used. E. If the physician/group is at substantial financial risk, the Contractor shall report proof the physician/group has adequate stop loss coverage, including amount and type of stop-loss.
Appears in 5 contracts
Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract, Medicaid Managed Care Contract
Contractor Provider Payments. If a Contractor includes a Physician Incentive Plan, the activities included shall comply with requirements set forth in 42 CFR 422.208 and 42 CFR 422.210. The Disclosures to the Department for Contractors with Physician Incentive Plans include the following:
A. The Contractor shall report whether services not furnished by a physician/group are covered by the incentive plan. No further disclosure is required if the Physician Incentive Payment does not cover services not furnished by a physician/group.
B. The Contractor shall report type of incentive arrangement, e.g. withhold, bonus, capitation.
C. The Contractor shall report percent of withhold or bonus (if applicable).
D. The Contractor shall report panel size, and if patients are pooled, the approved method used.
E. . If the physician/group is at substantial financial risk, the Contractor shall report proof the physician/group has adequate stop loss coverage, including amount and type of stop-loss.
Appears in 1 contract
Samples: Managed Care Contract (Wellcare Health Plans, Inc.)
