Common use of Medicaid Payments Clause in Contracts

Medicaid Payments. MDHHS will provide the PIHP eight managed care payments each month for the Medicaid covered specialty services under the listed Benefit Plan (BP). When applicable, additional payments may be scheduled (e.g. retro-rate implementation and up to 6 months retro eligibility). HIPAA compliant 834 and 820 transactions will provide eligibility and remittance information. • Base Rates for Benefit Plan (BHMA, BHMA-MHP, BHMA-HMP, BHMA-HMP-MHP, HSW- MC, SED-MC, CWP-MC) • Recovery of payments previously made for beneficiaries prior to MDHHS notification of death • Recovery of payments previously made for beneficiaries, who upon retrospective review, did not meet all the Benefit Plan enrollment requirements • Modifications to any of the Benefit Plan’s rate development factors • For HSW enrollees of a PIHP that includes the county of financial responsibility (COFR), referred to as the “responsible PIHP”, but whose county of residence is in another PIHP, referred to as the “residential PIHP”, the HSW capitation payment will be paid to the COFR within the “responsible PIHP” based on the multiplicative factor for the “residential PIHP”. The PIHP must be able to receive and transmit HIPAA compliant files, such as: • 834 – Enrollment/Eligibility • 820 – Payment / Remittance Advice • 837 – Encounter

Medicaid Payments. MDHHS will provide the PIHP eight with required managed care payments each month for the Medicaid covered specialty services under the listed Benefit Plan (BP). When applicable, additional payments may be scheduled (e.g. retro-rate implementation and up to 6 months retro eligibility). HIPAA compliant 834 and 820 transactions will provide eligibility and remittance information. • Base Rates for Benefit Plan (BHMA, BHMA-MHP, BHMA-HMP, BHMA-HMP-MHP, HSW- MC, SED-MC, CWP-MC) • Recovery of payments previously made for beneficiaries prior to MDHHS notification of death • Recovery of payments previously made for beneficiaries, who upon retrospective review, did not meet all the Benefit Plan enrollment requirements • Modifications to any of the Benefit Plan’s rate development factors • For HSW enrollees of a PIHP that includes the county of financial responsibility (COFR), referred to as the “responsible PIHP”, but whose county of residence is in another PIHP, referred to as the “residential PIHP”, the HSW capitation payment will be paid to the COFR within the “responsible PIHP” based on the multiplicative factor for the “residential PIHP”. The PIHP must be able to receive and transmit HIPAA compliant files, such as: • 834 – Enrollment/Eligibility • 820 – Payment / Remittance Advice • 837 – Encounter