Common use of Kick Payments Clause in Contracts

Kick Payments. 1. The Agency shall pay the Health Plan one kick payment for the following covered services for enrollees who are not also eligible for Medicare: a. Each obstetrical delivery, and b. Each covered transplant. 2. The Agency shall make kick payments in the amounts indicated in Attachment I. a. For kick payment purposes, an obstetrical delivery includes all births resulting from the delivery; therefore, if an obstetrical delivery results in multiple births, the Agency will make only one kick payment. This includes still births as specified in the Medicaid Physicians Services Handbook. b. For Health Plans under Contract as specialty plans, reimbursement for kick payment services will be counted toward the enrollee’s benefit maximum. 3. To receive a kick payment, the Health Plan must adhere to the specific requirements listed in subsections 4. and 5. below and adhere to the following requirements: a. The Health Plan must have provided the covered kick payment service while the recipient was enrolled in the Health Plan; and b. The Health Plan shall submit any required documentation to the Agency upon its request in order to receive the kick payment applicable to the covered service provided. 4. In addition to subsection 3. above, to receive a kick payment for covered transplants provided to an enrollee without Medicare, the Health Plan shall also comply with the following requirements: a. For each transplant provided, the Health Plan shall submit an accurate and complete CMS-1500 claim form (CMS-1500) and operative report to the fiscal agent within the required Medicaid FFS claims submittal timeframes b. The Health Plan shall list itself as both the pay-to and the treating provider on the CMS- 1500; and c. The Health Plan shall use the following list of transplant procedure codes relative to the type of transplant performed when completing Field 24 D on the CMS-1500: 32851 lung single, without bypass 32852 lung single, with bypass 32853 lung double, without bypass 32854 lung double, with bypass 33945 heart transplant with or without recipient cardiectomy 47135 liver, allotransplantation, orthotopic, partial or whole from cadaver or living donor 47136 liver, heterotopic, partial or whole from cadaver or living donor any age 5. In addition to subsection 3. above, to receive a kick payment for the covered obstetrical delivery provided to an enrollee, the Health Plan shall also comply with the following requirements: a. The Health Plan shall submit an accurate and complete claim form in sufficient time to be received by the fiscal agent within nine months following the date of service delivery. The Health Plan shall submit the claim electronically in a HIPAA compliant X12 837P format; b. The Health Plan shall list itself as both the pay-to and the treating provider; and c. The Health Plan shall use the following list of delivery procedure codes relative to the type of delivery performed when submitting the X12 837P transaction: 59409 Vaginal delivery only 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care

Kick Payments. 1. The Agency shall pay the Health Plan one kick payment for the following covered services for enrollees who are not also eligible for Medicare: a. Each obstetrical delivery, and b. Each covered transplant. 2. The Agency shall make kick payments in the amounts indicated in Attachment I. a. For kick payment purposes, an obstetrical delivery includes all births resulting from the delivery; therefore, if an obstetrical delivery results in multiple births, the Agency will make only one kick payment. This includes still births as specified in the Medicaid Physicians Services Handbook. b. For Health Plans under Contract as specialty plans, reimbursement for kick payment services will be counted toward the enrollee’s benefit maximum. 3. To receive a kick payment, the Health Plan must adhere to the specific requirements listed in subsections 4. and 5. below and adhere to the following requirements: a. The Health Plan must have provided the covered kick payment service while the recipient was enrolled in the Health Plan; and b. The Health Plan shall submit any required documentation to the Agency upon its request in order to receive the kick payment applicable to the covered service provided. 4. In addition to subsection 3. above, to receive a kick payment for covered transplants provided to an enrollee without Medicare, the Health Plan shall also comply with the following requirements: a. For each transplant provided, the Health Plan shall submit an accurate and complete CMS-1500 claim form (CMS-1500) and operative report to the fiscal agent within the required Medicaid FFS claims submittal timeframes b. The Health Plan shall list itself as both the pay-to and the treating provider on the CMS- 1500CMS-1500; and c. The Health Plan shall use the following list of transplant procedure codes relative to the type of transplant performed when completing Field 24 D on the CMS-1500: 32851 lung single, without bypass 32852 lung single, with bypass 32853 lung double, without bypass 32854 lung double, with bypass 33945 heart transplant with or without recipient cardiectomy 47135 liver, allotransplantation, orthotopic, partial or whole from cadaver or living donor 47136 liver, heterotopic, partial or whole from cadaver or living donor any age 5. In addition to subsection 3. above, to receive a kick payment for the covered obstetrical delivery provided to an enrollee, the Health Plan shall also comply with the following requirements: a. The Health Plan shall submit an accurate and complete claim form in sufficient time to be received by the fiscal agent within nine months following the date of service delivery. The Health Plan shall submit the claim electronically in a HIPAA compliant X12 837P format; b. The Health Plan shall list itself as both the pay-to and the treating provider; and c. The Health Plan shall use the following list of delivery procedure codes relative to the type of delivery performed when submitting the X12 837P transaction: 59409 Vaginal delivery only 59410 Vaginal delivery including postpartum care 59515 Cesarean delivery including postpartum care 59612 Vaginal delivery only, after previous cesarean delivery 33945 heart transplant with or without recipient cardiectomy 59614 Vaginal delivery only, after previous cesarean delivery including postpartum care 59622 Cesarean delivery only, following attempted vaginal delivery after previous cesarean delivery including postpartum care