Encounter a. A service or item provided to a patient through the health care system. Examples include but are not limited to:
Encounter. An individual service or procedure provided to a Beneficiary that would result in a claim if the service or procedure were to be reimbursed as Fee-For-Service under the ODM Medical Program.
Encounter. Any Health Care Service or bundle of related Health Care Services provided to one Enrollee by one Health Care Professional within one time period. Any Health Care Services provided must be recorded in the Enrollee’s health record.
Encounter. A service or item provided to a patient through the health care system. Examples include but are not limited to: o Office visits o Surgical procedures o Radiology (including professional and/or technical components) o Durable medical equipment o Emergency transportation to a hospital o Institutional stays (inpatient hospital, rehabilitation stays) o HealthCheck screens • A service or item not directly provided by the PIHP, but for which the PIHP is financially responsible. An example would include an emergency service provided by an out-of-network provider or facility. • A service or item not directly provided by the PIHP, and for which no claim is submitted but for which the PIHP may supplement its encounter data set. Such services might include HealthCheck screens for which no claims have been received and if no claim is received, the PIHP must have conducted a medical chart review. Examples of services or items the PIHP may include are: o HealthCheck Services o Lead Screening and Testing o Immunizations Services or items as used above include those services and items not covered by FCMH Program, but which the PIHP chooses to provide as part of its product. Examples include educational services, certain over-the-counter drugs, and delivered meals. Encounter Priced Amount: The fee-for-service equivalent rate assigned to an encounter.
Encounter. Any Health Care Service or bundle of related Covered Services provided to one Enrollee by one Health Care Professional within one time period. Any Covered Services provided must be recorded in the Enrollee’s health record. Encounter Data – Detailed data about individual services provided by a capitated managed care entity. The level of detail about each service reported is similar to that of a standard claim form. Enrollee
Encounter. Any Covered Service provided to a Covered Person, regardless of whether it has an associated claim.
Encounter. A distinct set of services provided to an Enrollee in a face-to-face setting on the dates that the services were delivered, regardless of whether the Provider is paid on a Fee-for-Service or Capitated basis. Encounters with more than one Health Care Professional, and multiple Encounters with the same Health Care Professional, that take place on the same day in the same location will constitute a single Encounter, except when the Enrollee, after the first Encounter, suffers an illness or injury requiring an additional diagnosis or treatment.
Encounter. Covered Service or group of Covered Services delivered by a Provider to an Enrollee during a visit between the Enrollee and Provider.
Encounter. An encounter is a professional face-to-face contact or transaction between a Participant and a Provider who delivers services. An encounter is comprised of the procedure(s) or service(s) rendered during the contact. An encounter should be operationalized in an information system as each unique occurrence of Participant and Provider.
Encounter. A service or item provided to a patient through the health care system. Examples include but are not limited to: o Office visits o Surgical procedures o Radiology (including professional and/or technical components) o Durable medical equipment o Emergency transportation to a hospital o Institutional stays (inpatient hospital, rehabilitation stays) o HealthCheck screens • A service or item not directly provided by the HMO, but for which the HMO is financially responsible. An example would include an emergency service provided by an out-of-network provider or facility. • A service or item not directly provided by the HMO, and for which no claim is submitted but for which the HMO may supplement its encounter data set. Such services might include HealthCheck screens for which no claims have been received and if no claim is received, the HMO must have conducted a medical chart review. Examples of services or items the HMO may include are: o HealthCheck Services o Lead Screening and Testing o Immunizations Services or items as used above include those services and items not covered by BadgerCare Plus and Medicaid SSI, but which the HMO chooses to provide as part of its managed care product. Examples include educational services, certain over-the-counter drugs, and delivered meals. Encounter Priced Amount: The fee-for-service equivalent rate assigned to an encounter.
