Encounter Data Submission Penalties Sample Clauses

Encounter Data Submission Penalties. Based on Blue Shield’s quarterly determinations and following no less than thirty (30) days prior notice to Group, Blue Shield may withhold a portion of Group’s Capitation, as set forth in Exhibit C., in the event that Blue Shield determines that a significant portion (as described in the Provider Manual) of the monthly Encounter Data which Group is obligated to provide (Paragraph 2.12) has not been delivered to Blue Shield within the prior quarter. If at the quarterly determination next following such withhold, Blue Shield determines that Group has satisfactorily delivered to Blue Shield the previously non-delivered Encounter Data, such withheld Capitation shall be paid to Group, without interest. In the event that Group does not deliver such Encounter Data to Blue Shield prior to such quarterly determination, Blue Shield shall be entitled to retain such withheld Capitation and will continue to deduct from the Group’s Capitation and retain such deductions as described in Exhibit C. from each quarter’s Capitation. If at a later date Group resumes the timely and complete submission of encounter data as required by this Agreement, then Blue Shield will cease deducting these penalties from Group’s Capitation beginning as of the month in which compliance is demonstrated by Group.
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Encounter Data Submission Penalties. In the event that Group fails to comply with the encounter data submission requirements described in Paragraph 2.12 hereof, then the amounts to be deducted or withheld from Group’ Capitation on a monthly basis as provided in Paragraph 7.11 hereof are identified in Exhibit C-l as “Penalties for Deficient Encounter Data Submission”. *** *** Confidential Treatment requested Exhibit C-1 HMO IPA/Medical Group Agreement Capitation Rates for North West Orange County Medical Group Effective Date: 02/01/2003 As of 02/01/2003, the effective net yield (which includes the deduction for Stop Loss, if applicable) for the following PMPMs and factors are *** for the HMO Group. *** for HMO IFP. *** for POS, *** for the PERS Group, and *** pmpm in aggregate, based on the 07/01/2002 membership. The actual capitation payment for each month will be calculated based on the actual member mix for each age/sex/copay level category.
Sample 1
Encounter Data Submission Penalties. In the event that Group fails to comply with the encounter data submission requirements described in Paragraph 2.12 hereof, then the amounts to be deducted or withheld from Group’ Capitation on a monthly basis as provided in Paragraph 7.11 hereof are identified in Exhibit C-l as “Penalties for Deficient Encounter Data Submission”. *** Exhibit C- l HMO IPA/Medical Group Agreement Capitation Rates for Professional Care IPA - 385U9 Effective Date: 01/01/2003 As of 01/01/2003, the effective net yield (which includes the deduction for Stop Loss, if applicable) for the following PMPMs and factors are *** for the HMO Group, *** for HMO IFP, *** for POS, and *** pmpm in aggregate, based on the 08/01/2002 membership. The actual capitation payment for each month will be calculated based on the actual member mix for each age/sex/copay level category.
Sample 1
Encounter Data Submission Penalties. In the event that Group fails to comply with the encounter data submission requirements described in Paragraph 2.12 hereof, then the amounts to be deducted or withheld from Group Capitation on a monthly basis as provided in Paragraph 7.11 hereof are identified in Exhibit C-1 as “Penalties for Deficient Encounter Data Submission”. <<>> [LOGO] Blue Shield of California An Independent Member of the Blue Shield Association Exhibit C-1 HMO IPA/Medical Group Agreement CAPITATION RATES Name of Group: PROSPECT MEDICAL GROUP, INC. Effective Date: As of / /2004, the effective net yield (which includes the deduction for Stop Loss, if applicable) for the following PMPMs and factors are $47.21 for the HMO Group, $36.92 for HMO IFP, $38.83 for POS, $45.65 for the PERS Group, and $45.79 pmpm in aggregate, based on the 07/01/2003 membership. The actual capitation payment for each month will be calculated based on the actual member mix for each age/sex/copay level category.
Sample 1

Related to Encounter Data Submission Penalties

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