OTHER HOSPITAL SERVICES a. Devices surgically implanted during a hospital confinement or during an outpatient surgery performed at the Hospital outpatient surgery center or a free-standing surgery center.
OTHER HOSPITAL SERVICES. The following hospital services provided to Central Oregon CCO OHP members will be reimbursed via methods other than the Hospital Capitation Payment: • Professional Services billed by SCHS professional and hospital-based providers and billed on a CMS 1500 form or UB-04 or other form, which, unless covered under a separate agreement, will be reimbursed at one hundred percent (100%) of current OHP Allowable Amounts and eight percent (8%) claims risk withhold. • Services provided by and billed under St. Xxxxxxx Medical Group and St. Xxxxxxx Family Care. • Services provided by and billed under Sageview Behavioral Health. • Inpatient and outpatient Behavioral Health/CD, Alcohol/Drug – Residential, or Behavioral Health – Residential services funded via OHP’s Behavioral Health/CD, Alcohol/Drug - Residential or Behavioral Health – Residential revenue. • Inpatient and outpatient Dental Services funded as the Oregon Health Plan and OHA’s Dental revenue via dental care providers and Dental Care Organizations (DCOs).
OTHER HOSPITAL SERVICES a. Devices surgically implanted during a hospital confinement or during an outpatient surgery performed at the Hospital outpatient surgery center or a free-standing ASC. b. Treatment programs for outpatient substance abuse as defined by Medicare. c. Appealed Services - Hospital Services denied by IPA and PacifiCare which are found on appeal or arbitration through the Subscriber grievance resolution process to be Hospital Services which the Subscriber was entitled to have furnished under the PacifiCare Secure Horizons health care delivery system. d. Chemotherapy Drugs (inpatient and outpatient). e. Self injectable medications
OTHER HOSPITAL SERVICES a. Devices surgically implanted during a hospital confinement or during an outpatient surgery performed at the Hospital outpatient surgery center or a free-standing surgery center. b. Appealed Services - Hospital Services denied by a Participating Medical Group and PacifiCare which are found on appeal or arbitration through the Subscriber grievance resolution process to be Hospital Services which the Subscriber was entitled to have furnished under the Pacificare Health Plan. c. Chemotherapy Drugs (impatient and outpatient) d. Inpatient and outpatient dialysis (including professional fees) e. Other Health Care Services that must be performed in a hospital or surgicenter (e.g. angiograms)
OTHER HOSPITAL SERVICES a. Devices surgically implanted during a hospital confinement or during an outpatient surgery performed at the Hospital outpatient surgery center or a free-standing surgery center. b. Treatment programs for outpatient substance abuse as defined by Medicare. c. Appealed Services - Hospital Services denied by IPA and PacifiCare which are found on appeal or arbitration through the Subscriber grievance resolution process to be Hospital Services which the Subscriber was entitled to have furnished under the PacifiCare Secure Horizons health care delivery system. d. Chemotherapy Drugs (inpatient and outpatient).
