Out-of-Network Provider Reimbursement. The MCP shall reimburse out-of-network providers who provide services during the transition at 100% of the current Medicaid FFS provider rate for the specific service.
Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to Hoosier Healthwise members at a rate it negotiates with the out- of-network provider, or the lesser of the following: ▪ The charges billed by the provider; or ▪ 100% of the established Indiana Medicaid FFS reimbursement rates that exist for participating IHCP providers at the time the service was rendered.
Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to HIP members. The Contractor shall reimburse any out-of-network provider’s claim for authorized services according to administrative code 405 IAC 10-9-4 (b) and State statute IC 12-15-44.5-5.
Out-of-Network Provider Reimbursement. The Contractor shall reimburse any out-of-network provider’s claim for authorized services provided to HIP members at 98% of the Medicare rate or, if the service does not have a Medicare rate, 128% of the Medicaid rate for that service. Notwithstanding the foregoing, out- of-network services provided to HIP members eligible pursuant to Section 3.3.1 and billed by a hospital provider, shall be reimbursable at standard Medicaid rates, rather than the higher HIP Medicare rates. Contractor must reimburse claims for members who chose the MCE during the HPE application process on the admission date.
