Intelligent Assignment Sample Clauses

Intelligent Assignment. Enrollment activities specific to Two-Plan Counties and GMC Counties (Los Angeles, San Diego, San Bernardino, Santa Xxxxx, Riverside): 2.3.1.5.1. At least ninety (90) days prior to the start of the Cal MediConnect program, Contractor shall provide DHCS with a complete list of Network Providers and National Provider Identifier (NPI) numbers to assist in the assignment of eligible beneficiaries as part of the Passive Enrollment process. The Network Provider list will include all network providers for the Provider Network, where applicable. 2.3.1.5.2. Updates to the Network Provider list shall be sent to DHCS on a quarterly basis for the purposes of intelligent assignment, or as changes to the Provider Network are applied. 2.3.1.5.3. As part of the enrollment process, DHCS will initially assign an Enrollee to a Cal MediConnect Plan based on a hierarchical logic in accordance with Section 2.3.1.5.1. Enrollees shall have the ability to change Cal MediConnect Plans at any time. 2.3.1.5.3.1. DHCS shall utilize the following hierarchical logic to determine Primary Contractor Plan assignment: 2.3.1.5.3.1.1. If a beneficiary is in a Medi-Cal Managed Care Plan that is participating in the Cal MediConnect Program and is not enrolled in a Medicare Advantage product, DHCS will assign the beneficiary to the matching Cal MediConnect plan. 2.3.1.5.3.1.2. If the beneficiary is in a Medicare Advantage Dual Special Needs Plan owned by the parent organization of an MMP, DHCS will assign the beneficiary to the matching MMP. 2.3.1.5.3.1.3. If a beneficiary is in fee-for-service Medi-Cal and Medicare, DHCS will match the beneficiary’s highest utilized and paid prescribing and/or rendering provider data [based on the most recent and available twelve
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Intelligent Assignment. Enrollment activities specific to Two-Plan Counties and GMC Counties (Los Angeles, San Diego, San Bernardino, Santa Xxxxx, Riverside): 2.3.1.5.1. On a quarterly basis, Contractor shall provide DHCS with a complete list of Network Providers and National Provider Identifier (NPI) numbers to assist in the assignment of eligible beneficiaries as part of the Passive Enrollment process. The Network Provider list will include all Network Providers for the Provider Network, where applicable. 2.3.1.5.2. Updates to the Network Provider list shall be sent to DHCS on a quarterly basis for the purposes of intelligent assignment, or as changes to the Provider Network are applied. 2.3.1.5.3. As part of the Enrollment process, DHCS will exclude individuals identified as at-risk or potentially at-risk for abuse or overuse of specified prescription drugs per 42 C.F.R. §§ 423.100 and 423.153(f). 2.3.1.5.4. As part of the Passive Enrollment process, DHCS will initially assign an Enrollee to a Cal MediConnect Plan based on a hierarchical logic in accordance with Section 2.3.1.5.1. Subject to 42 C.F.R. §§ 423.100 and 423.153(f), Enrollees shall have the ability to change Cal MediConnect Plans at any time. 2.3.1.5.4.1. DHCS shall utilize the following hierarchical logic to determine Primary Contractor Plan assignment: 2.3.1.5.4.1.1. If a beneficiary is in a Medi-Cal 2.3.1.5.4.1.2. If the beneficiary is in a Medicare Advantage Dual Special Needs Plan owned by the parent organization of an MMP, DHCS will assign the beneficiary to the matching MMP. 2.3.1.5.4.1.3. If a beneficiary is in fee-for-service Medi-Cal and Medicare, DHCS will match the beneficiary’s highest utilized and paid prescribing and/or rendering provider data [based on the most recent and available twelve
Sample 1Sample 2
Intelligent Assignment. Enrollment activities specific to Two-Plan Counties and GMC Counties (Alameda, Los Angeles, San Diego, San Bernardino, Santa Xxxxx, Riverside): 2.3.1.5.1. At least ninety (90) days prior to the start of the Cal MediConnect program, Contractor shall provide DHCS with a complete list of Network Providers and National Provider Identifier (NPI) numbers to assist in the assignment of eligible beneficiaries as part of the Passive Enrollment process. The Network Provider list will include all network providers for the Provider Network, including those in the networks of the any Subcontracted Health Plans, where applicable. 2.3.1.5.2. Updates to the Network Provider list shall be sent to DHCS on a quarterly basis for the purposes of intelligent assignment, or as changes to the Provider Network are applied. 2.3.1.5.3. As part of the enrollment process, DHCS will initially assign an Enrollee to a Cal MediConnect Plan based on a hierarchical logic, which includes utilizing data, and applicable Subcontracted Health Plan Network Providers in accordance with Section 2.3.1.5.1. Enrollees shall have the ability to change Cal MediConnect Plans at any time. 2.3.1.5.3.1. DHCS shall utilize the following hierarchical logic to determine Primary Contractor Plan assignment: 2.3.1.5.3.1.1. If a beneficiary is in a Medi-Cal Managed Care Plan that is participating in the Cal MediConnect Program and is not enrolled in a Medicare Advantage product, DHCS will assign the beneficiary to the matching Prime Contractor plan. 2.3.1.5.3.1.2. If a beneficiary is in fee-for-service Medi-Cal and Medicare, DHCS will match the beneficiary’s highest utilized and paid prescribing and/or rendering provider data [based on the most recent and available twelve
Sample 1
Intelligent Assignment. Enrollment activities specific to Two-Plan Counties and GMC Counties (Los Angeles, San Diego, San Bernardino, Santa Xxxxx, Riverside): 2.3.1.5.1. At least ninety (90) days prior to the start of the Cal MediConnect program, Contractor shall provide DHCS with a complete list of Network Providers and National Provider Identifier (NPI) numbers to assist in the assignment of eligible beneficiaries as part of the Passive Enrollment process. The Network Provider list will include all network providers for the Provider Network, where applicable. 2.3.1.5.2. Updates to the Network Provider list shall be sent to DHCS on a quarterly basis for the purposes of intelligent assignment, or as changes to the Provider Network are applied. 2.3.1.5.3. As part of the enrollment process, DHCS will initially assign an Enrollee to a Cal MediConnect Plan based on a hierarchical logic in accordance with Section 2.3.1.5.1. Enrollees shall have the ability to change Cal MediConnect Plans at any time. 2.3.1.5.3.1. DHCS shall utilize the following hierarchical logic to determine Primary Contractor Plan assignment: 2.3.1.5.3.1.1. If a beneficiary is in a Medi-Cal 2.3.1.5.3.1.2. If a beneficiary is in fee-for-service Medi-Cal and Medicare, DHCS will match the beneficiary’s highest utilized and paid prescribing and/or rendering provider data [based on the most recent and available twelve
Sample 1

Related to Intelligent Assignment

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  • Amendment; Assignment This Agreement may be amended, superseded, canceled, renewed or extended, and the terms hereof may be waived, only by a written instrument signed by authorized representatives of the parties or, in the case of a waiver, by an authorized representative of the party waiving compliance. No such written instrument shall be effective unless it expressly recites that it is intended to amend, supersede, cancel, renew or extend this Agreement or to waive compliance with one or more of the terms hereof, as the case may be. Except for the Management Stockholder’s right to assign his or her rights under Section 4(a) or the Company’s right to assign its rights under Section 4(b), no party to this Agreement may assign any of its rights or obligations under this Agreement without the prior written consent of the other parties hereto.

  • Shift Assignments When an opening occurs in a shift assignment in an appropriate work group at a location, preference shall be given to employees within the classification who possess the training, ability and any required special qualifications to perform the work required, on the basis of seniority. In the event that no employee desires a shift assignment, employees shall be selected in order of inverse seniority. This provision shall not apply to necessary training assignments. This provision shall not in itself alter the practice of rotating shifts where such practice presently exists. No employee who has a regular shift assignment on the effective date of the Agreement shall be involuntarily displaced from such shift assignment as a result of this Article.

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  • The Assignment On or prior to the Purchase Date, World Omni will execute and deliver the RPA Assignment.

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  • Opinion of Intellectual Property Counsel for the Company Xxxxxx Xxxxxxx Xxxxxxxx & Xxxxxx, Professional Corporation, intellectual property counsel for the Company, shall have furnished to the Representatives, at the request of the Company, their written opinion, dated the Closing Date or the Additional Closing Date, as the case may be, and addressed to the Underwriters, in form and substance reasonably satisfactory to the Representatives.

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