Common use of Payment of HMO Referrals to Non-Affiliated Providers Clause in Contracts

Payment of HMO Referrals to Non-Affiliated Providers. For HMO approved referrals to non-affiliated providers, the HMO must either establish payment arrangements in advance, or the HMO is liable for payment only to the extent that BadgerCare Plus and/or Medicaid SSI pays, including Medicare deductibles, or would pay, its FFS providers for services.

Payment of HMO Referrals to Non-Affiliated Providers. For HMO approved referrals to non-affiliated providers, the HMO must either establish payment arrangements in advance, or the HMO is liable for payment only to the extent that BadgerCare Plus and/or Medicaid SSI pays, including Medicare deductibles, or would pay, its FFS providers for servicesservices to the AFDC and BadgerCare population. This condition does not apply to cases where there are specific subcontract agreements, MOUs or other binding agreements entered into before the referral.