Numeric. ESCORT Escort Services 15 Minute Unit 4 95 98 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit 2 101 102 Numeric -------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment /Risk Reduction Services 15 Minute Unit 4 [ILLEGIBLE] 106 -------------------------------------------------------------------------------------------------------------- ---------- * Medicare crossovers are amounts that are billed to Medicaid for those Medicaid clients who are also eligible for Medicare. EXHIBIT B (Page 2 of 3) -------------------------------------------------------------------------------------------------------------- UNIT OF FIELD FIELD NAME DESCRIPTION MEASUREMENT LENGTH START COL. END COL. TEXT/NUMERIC -------------------------------------------------------------------------------------------------------------- FINM RRS Financial Maintenance/Risk Reduction Services 15 Minute Unit 4 107 110 Numeric -------------------------------------------------------------------------------------------------------------- HDMEAL Home Delivered Meal Meal 2 111 112 Numeric -------------------------------------------------------------------------------------------------------------- HOMESRVS Homemaker Services 15 Minute Unit 4 113 116 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 117 120 Numeric -------------------------------------------------------------------------------------------------------------- Days 2 121 122 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 123 126 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 127 130 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 131 134 Numeric -------------------------------------------------------------------------------------------------------------- PERS_I Personal Emergency Response System Installation Job 2 135 136 Numeric -------------------------------------------------------------------------------------------------------------- PERS_M Personal Emergency Response System - Maintenance Day 2 137 138 Numeric -------------------------------------------------------------------------------------------------------------- PEST_I Pest Control - Initial Visit Job 2 139 140 Numeric -------------------------------------------------------------------------------------------------------------- Month 1 141 141 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 142 145 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 146 149 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 150 153 Numeric -------------------------------------------------------------------------------------------------------------- Visit 2 154 155 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 156 159 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 160 163 Numeric -------------------------------------------------------------------------------------------------------------- Days 2 164 165 Numeric -------------------------------------------------------------------------------------------------------------- Visit 4 166 169 Numeric -------------------------------------------------------------------------------------------------------------- SPTH 15 Minute Unit 4 170 173 Numeric -------------------------------------------------------------------------------------------------------------- TRANSPOR Transportation Services (not included in Escort or Adult Day Health services) Trips 3 174 176 Numeric -------------------------------------------------------------------------------------------------------------- OTH_UNIT Other LTC Service not listed (unit) Unit/Visit 6 177 182 Numeric -------------------------------------------------------------------------------------------------------------- 35 183 217 Text -------------------------------------------------------------------------------------------------------------- Amount Paid 6 -------------------------------------------------------------------------------------------------------------- 35 -------------------------------------------------------------------------------------------------------------- EXHIBIT B FILE 2: ACUTE CARE SERVICES
Appears in 1 contract
Samples: Amerigroup Corp
Numeric. ESCORT Escort Services 15 Minute Unit 4 95 98 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit 2 101 102 Numeric -------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment /Risk Reduction Services 15 Minute Unit 4 [ILLEGIBLE] 106 -------------------------------------------------------------------------------------------------------------- ---------- * Medicare crossovers are amounts that are billed to Medicaid for those Medicaid clients who are also eligible for Medicare. EXHIBIT B (Page 2 of 3AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 8 OF 12 AHCA Form 2100-0002(Rev. OCT 02) -------------------------------------------------------------------------------------------------------------- UNIT OF AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 ---------------------------------------------------------------------------------------------------------------------------- FIELD START FIELD NAME DESCRIPTION UNIT OF MEASUREMENT LENGTH START COL. END COL. TEXT/NUMERIC -------------------------------------------------------------------------------------------------------------- FINM RRS ---------------------------------------------------------------------------------------------------------------------------- ESCORT Escort Services 15 Minute Unit 4 95 98 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric ---------------------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit 2 101 102 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment/Risk Reduction Services 15 Minute Unit 4 103 106 Numeric ---------------------------------------------------------------------------------------------------------------------------- FINM_RRS Financial Maintenance/Risk Reduction Services 15 Minute Unit 4 107 110 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- HDMEAL Home Delivered Meal Meals Meal 2 111 112 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- HOMESRVS Homemaker Services 15 Minute Unit 4 113 116 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- MH_CM Mental Health Case Management 15 Minute Unit 4 117 120 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- SNF Nursing Facility Services- Long-term Days 2 121 122 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- NUTR_RRS Nutritional Assessment/Risk Reduction Services 15 Minute Unit 4 123 126 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- OT Occupational Therapy 15 Minute Unit 4 127 130 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- PCS Personal Care Services 15 Minute Unit 4 131 134 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- PERS_I Personal Emergency Response System Installation Job 2 135 136 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- PERS_M Personal Emergency Response System - System- Maintenance Day 2 137 138 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- PEST_I Pest Control - Initial Visit Job 2 139 140 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- PEST_M Pest Control - Maintenance Month 1 141 141 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- PT Physical Therapy 15 Minute Unit 4 142 145 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- RISKREDU Physical Risk Assessment and Reduction 15 Minute Unit 4 146 149 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- PRIVNURS Private Duty Nursing Services 15 Minute Unit 4 150 153 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- PT_R Registered Physical Therapist Visit 2 154 155 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- RSPTH Respiratory Therapy 15 Minute Unit 4 156 159 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- RESP_HM Respite Care- In Home 15 Minute Unit 4 160 163 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- RESP_FAC Respite Care- Facility-Based Days 2 164 165 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- NURSE Skilled Nursing Visit 4 166 169 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- SPTH Speech Therapy 15 Minute Unit 4 170 173 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- TRANSPOR Transportation Services (not included in Escort or Adult Day Health services) Trips 3 174 176 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- OTH_UNIT Other LTC Service not listed (unit) Unit/Unit/ Visit 6 177 182 Numeric -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- DESCR_1 Description of other LTC service 35 183 217 Text -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- OTH_$$ Other LTC service not listed (amount) Amount Paid 6 -------------------------------------------------------------------------------------------------------------- 218 223 Numeric ---------------------------------------------------------------------------------------------------------------------------- DESCR_2 Description of other LTC service 35 -------------------------------------------------------------------------------------------------------------- EXHIBIT B 224 258 Text ---------------------------------------------------------------------------------------------------------------------------- AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 9 OF 12 AHCA Form 2100-0002 (Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003 FILE 2: ACUTE CARE SERVICES
Appears in 1 contract
Samples: Amerigroup Corp
Numeric. ESCORT Escort Services 15 Minute Unit 4 RX_$$ Pharmaceuticals Amount Paid 6 95 98 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit ------------------------------------------------------------------------------------------------------------------------------------ PA Physical Assistant Visit 2 101 102 Numeric -------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment /Risk Reduction ------------------------------------------------------------------------------------------------------------------------------------ PA_$$ Physical Assistant Costs Amount Paid 6 103 108 Numeric ------------------------------------------------------------------------------------------------------------------------------------ MD Physician Services 15 Minute Unit 4 [ILLEGIBLE] 106 -------------------------------------------------------------------------------------------------------------- ---------- * Medicare crossovers are amounts that are billed to Medicaid for those Medicaid clients who are also eligible for Medicare. EXHIBIT B (Page Visit 2 of 3) -------------------------------------------------------------------------------------------------------------- UNIT OF FIELD FIELD NAME DESCRIPTION MEASUREMENT LENGTH START COL. END COL. TEXT/NUMERIC -------------------------------------------------------------------------------------------------------------- FINM RRS Financial Maintenance/Risk Reduction Services 15 Minute Unit 4 107 109 110 Numeric -------------------------------------------------------------------------------------------------------------- HDMEAL Home Delivered Meal Meal 2 ------------------------------------------------------------------------------------------------------------------------------------ MD_$$ Physician Services Costs Amount Paid 6 111 112 Numeric -------------------------------------------------------------------------------------------------------------- HOMESRVS Homemaker Services 15 Minute Unit 4 113 116 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 ------------------------------------------------------------------------------------------------------------------------------------ OUTPT Outpatient Hospital Services Encounter 3 117 119 Numeric ------------------------------------------------------------------------------------------------------------------------------------ OUTPT_$$ Outpatient Hospital Services Costs Amount Paid 6 120 125 Numeric -------------------------------------------------------------------------------------------------------------- Days ------------------------------------------------------------------------------------------------------------------------------------ PODIATRY Podiatry Visit 2 121 122 126 127 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 123 126 ------------------------------------------------------------------------------------------------------------------------------------ PODIAT$$ Podiatry Costs Amount Paid 6 128 133 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 127 130 ------------------------------------------------------------------------------------------------------------------------------------ RURAL Rural Health Services Visit 2 134 135 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 131 134 Numeric -------------------------------------------------------------------------------------------------------------- PERS_I Personal Emergency Response System Installation Job 2 135 ------------------------------------------------------------------------------------------------------------------------------------ RURAL$$ Rural Health Services Costs Amount Paid 6 136 Numeric -------------------------------------------------------------------------------------------------------------- PERS_M Personal Emergency Response System - Maintenance Day 2 137 138 Numeric -------------------------------------------------------------------------------------------------------------- PEST_I Pest Control - Initial Visit Job 2 139 140 Numeric -------------------------------------------------------------------------------------------------------------- Month 1 141 141 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 ------------------------------------------------------------------------------------------------------------------------------------ SNFREHAS Skilled nursing facility Amount Paid 6 142 145 147 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 146 149 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 150 services - rehabilitation** ------------------------------------------------------------------------------------------------------------------------------------ EYE_$$ Visual Services including eyeglasses Amount Paid 6 148 153 Numeric -------------------------------------------------------------------------------------------------------------- Visit 2 154 155 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 156 159 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 160 163 Numeric -------------------------------------------------------------------------------------------------------------- Days 2 164 165 Numeric -------------------------------------------------------------------------------------------------------------- Visit 4 166 169 Numeric -------------------------------------------------------------------------------------------------------------- SPTH 15 Minute Unit 4 170 173 Numeric -------------------------------------------------------------------------------------------------------------- TRANSPOR Transportation Services (not included in Escort or Adult Day Health services) Trips 3 174 176 Numeric -------------------------------------------------------------------------------------------------------------- OTH_UNIT ------------------------------------------------------------------------------------------------------------------------------------ OTH UNIT Other LTC Acute Service not listed (unit) Unit/Visit 6 177 182 154 159 Numeric -------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ DESCR_1 Description of other Acute service 35 183 217 160 194 Text -------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ OTH_$$ Other Acute service not listed (amount) Amount Paid 6 -------------------------------------------------------------------------------------------------------------- 195 200 Numeric ------------------------------------------------------------------------------------------------------------------------------------ DESCR_2 Description of other Acute service 35 -------------------------------------------------------------------------------------------------------------- EXHIBIT B FILE 2: ACUTE CARE SERVICES201 235 Text ------------------------------------------------------------------------------------------------------------------------------------ **Medicare Crossovers AHCA CONTRACT NO. FA309, AMENDMENT NO. 003, PAGE 10 OF 12 AHCA Form 2100-0002 (Rev. OCT 02) AMERIGROUP FLORIDA, INC. MEDICAID HMO CONTRACT FEBRUARY 2003
Appears in 1 contract
Samples: Amerigroup Corp
Numeric. ESCORT Escort Services 15 Minute Unit 4 X_$$ Pharmaceuticals Amount Paid 6 95 98 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_I Family Training Services (Individual) 15 Minute Unit 2 99 100 Numeric -------------------------------------------------------------------------------------------------------------- FAMT_G Family Training Services (Group) 15 Minute Unit ------------------------------------------------------------------------------------------------------------- PA Physical Assistant Visit 2 101 102 Numeric -------------------------------------------------------------------------------------------------------------- FINARRS Financial Assessment /Risk Reduction ------------------------------------------------------------------------------------------------------------- PA_$$ Physical Assistant Costs Amount Paid 6 103 106 Numeric ------------------------------------------------------------------------------------------------------------- MD Physician Services 15 Minute Unit 4 [ILLEGIBLE] 106 -------------------------------------------------------------------------------------------------------------- ---------- * Medicare crossovers are amounts that are billed to Medicaid for those Medicaid clients who are also eligible for Medicare. EXHIBIT B (Page Visit 2 of 3) -------------------------------------------------------------------------------------------------------------- UNIT OF FIELD FIELD NAME DESCRIPTION MEASUREMENT LENGTH START COL. END COL. TEXT/NUMERIC -------------------------------------------------------------------------------------------------------------- FINM RRS Financial Maintenance/Risk Reduction Services 15 Minute Unit 4 107 109 110 Numeric -------------------------------------------------------------------------------------------------------------- HDMEAL Home Delivered Meal Meal 2 ------------------------------------------------------------------------------------------------------------- Physician Services Costs Amount Paid 6 111 112 Numeric -------------------------------------------------------------------------------------------------------------- HOMESRVS Homemaker Services 15 Minute Unit 4 113 116 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 ------------------------------------------------------------------------------------------------------------- Encounter 3 117 119 Numeric ------------------------------------------------------------------------------------------------------------- OUTPT_$$ Amount Paid 6 120 125 Numeric -------------------------------------------------------------------------------------------------------------- Days ------------------------------------------------------------------------------------------------------------- Visit 2 121 122 126 127 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 123 126 ------------------------------------------------------------------------------------------------------------- PODIAT$$ Amount Paid 6 128 133 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 127 130 ------------------------------------------------------------------------------------------------------------- Rural Health Services Visit 2 134 135 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 131 134 Numeric -------------------------------------------------------------------------------------------------------------- PERS_I Personal Emergency Response System Installation Job 2 135 ------------------------------------------------------------------------------------------------------------- Rural Health Services Costs Amount Paid 6 136 Numeric -------------------------------------------------------------------------------------------------------------- PERS_M Personal Emergency Response System - Maintenance Day 2 137 138 Numeric -------------------------------------------------------------------------------------------------------------- PEST_I Pest Control - Initial Visit Job 2 139 140 Numeric -------------------------------------------------------------------------------------------------------------- Month 1 141 141 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 ------------------------------------------------------------------------------------------------------------- SNFREHAS Skilled nursing facility services - rehabilitation ** Amount Paid 6 142 145 147 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 146 149 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 150 ------------------------------------------------------------------------------------------------------------- EYE_$$ Visual Services including eyeglasses Amount Paid 6 148 153 Numeric -------------------------------------------------------------------------------------------------------------- Visit 2 154 155 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 156 159 Numeric -------------------------------------------------------------------------------------------------------------- 15 Minute Unit 4 160 163 Numeric -------------------------------------------------------------------------------------------------------------- Days 2 164 165 Numeric -------------------------------------------------------------------------------------------------------------- Visit 4 166 169 Numeric -------------------------------------------------------------------------------------------------------------- SPTH 15 Minute Unit 4 170 173 Numeric -------------------------------------------------------------------------------------------------------------- TRANSPOR Transportation Services (not included in Escort or Adult Day Health services) Trips 3 174 176 Numeric -------------------------------------------------------------------------------------------------------------- OTH_UNIT ------------------------------------------------------------------------------------------------------------- Other LTC Acute Service not listed (unit) Unit/Visit 6 177 182 154 159 Numeric -------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- DESCR 1 Description of other Acute service 35 183 217 160 194 Text -------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- OTH_$ Other Acute Service not listed (amount) Amount Paid 6 -------------------------------------------------------------------------------------------------------------- 195 200 Numeric ------------------------------------------------------------------------------------------------------------- Description of other Acute service 35 -------------------------------------------------------------------------------------------------------------- 201 235 Text ------------------------------------------------------------------------------------------------------------- **Medicare Crossovers EXHIBIT B FILE 2: ACUTE CARE SERVICESC (Page 1 of 1) (Plan Name) REPORT OF GRIEVANCES (Reporting Quarter) Were any new grievances filed during this reporting quarter? YES [ ] NO [ ] ------------------------------------------------------------------------------------------------------------------------------- ENROLLEE'S ENROLLEE'S ENROLLEE'S ENROLLEE'S GRIEVANCE GRIEVANCE EXPEDITED DISPOSITION DISPOSITION RESOLVED? LAST NAME FIRST NAME MEDICAID SOCIAL TYPE * DATE REQUEST? TYPE ** DATE (Y OR N) ID # SECURITY # (Y OR N) -------------------------------------------------------------------------------------------------------------------------------
Appears in 1 contract
Samples: Amerigroup Corp
