Common use of Other Benefit Expense Clause in Contracts

Other Benefit Expense. Any service provided directly to an Enrollee not capable of being sent as Encounter Data due to there not being appropriate codes or similar issues may be sent to the Department on a report identifying the Enrollee, the service and the cost. Such costs will be included in Benefit Expense.

Other Benefit Expense. Any service provided directly to an Enrollee not capable of being sent as Encounter Data to the Department due to there not being appropriate codes or similar issues may be sent to the Department on a report identifying the Enrollee, the service and the cost. Such costs will be included in Benefit Expense.; and

Other Benefit Expense. Any service provided directly to an Enrollee not capable of being sent as Encounter Data due to there not being appropriate codes or similar issues may be sent to the Department Agency on a report identifying the Enrollee, the service and the cost, along with clear documentation of the methodology for determining payment amounts. Such costs will be included in Benefit ExpenseExpense upon the Agency’s approval. Other Benefit Expense will be limited to State Plan approved services and B3 services for the Member and will not include any additional value added services.