Indicator Form. Form supplied to inpatient hospitals by EOHHS that is used to notify the Contractor when the hospital discovers that an Enrollee has comprehensive insurance coverage other than Medicare or Medicaid. Total Capitation Rate Revenue — The sum of the monthly capitation payments for Demonstration Year 1 (reflecting coverage of Medicare Parts A/B services, Medicare Part D services and Medicaid services, pursuant to Appendix A of this contract) including: 1) the application of risk adjustment methodologies, as described in Section 4.2.D; 2) any payment adjustments as a result of the reconciliation described in Section 4.5; and 3) any payments as a result of the High-Cost Risk Pool, as described in Section 4.2.E. Total Capitation Rate Revenue will be calculated as if all Contractors had received the full quality withhold payment. Total Adjusted Expenditures — The sum of the Adjusted Service Expenditures and the Adjusted Non-Service Expenditures.
Indicator Form. Form supplied to inpatient hospitals by EOHHS that is used to notify the Contractor when the hospital discovers that an Enrollee has comprehensive insurance coverage other than Medicare or Medicaid. Total Capitation Rate Revenue — The sum of the monthly capitation payments for Demonstration Year 1 (reflecting coverage of Medicare Parts A/B services, Medicare Part D services and Medicaid services, pursuant to Appendix A and defined in Appendix B of this Contract) including: The application of risk adjustment methodologies, as described in Section 4.3.5; Any payment adjustments as a result of the reconciliation described in Section 4.6; and Any payments as a result of the High‑Cost Risk Pool, as described in Section 4.3.6. Total Capitation Rate Revenue will be calculated as if all Contracter had received the full quality withhold payment.
Indicator Form. Form supplied to inpatient hospitals by EOHHS that is used to notify the Contractor when the hospital discovers that an Enrollee has comprehensive insurance coverage other than Medicare or Medicaid. Total Capitation Rate Revenue — The sum of the monthly capitation payments for Demonstration Year 1 (reflecting coverage of Medicare Parts A/B services, Medicare Part D services and Medicaid services, pursuant to Appendix A and defined in Appendix B of this Contract) including: The application of risk adjustment methodologies, as described in
