Payment of Providers Sample Clauses

Payment of Providers. The Contractor shall reimburse Providers as follows:

Payment of Providers. Payment of both contracted and non-participating providers shall, at a minimum, follow the same standards as those contained in 42 CFR §447.45 (d)(1)-(3), (5) and (6) as determined by XXXXXX. This includes the following: Providers must submit all claims no later than 12 months from the date of service. The Contractor shall pay 90% of all clean claims from practitioners, either in individual or group practice or who practice in shared health facilities, within thirty (30) days of the date of receipt. The Contractor shall pay 99% of all clean claims from practitioners, either in individual or group practice or who practice in shared health facilities, within ninety (90) days of the date of receipt. These provisions shall also apply to payments to hospitals. The date of receipt is the date the Contractor receives the claim, as indicated by its data stamp on the claim. The date of payment is the date of the check or other form of payment. The MCO and its providers may, by mutual agreement, establish an alternative payment schedule.

Payment of Providers. 1. Network Provider Reimbursement Personal Choice reimbursement programs for health care Providers are intended to encourage the provision of quality, cost-effective care for Personal Choice members. Set forth below is a general description of Personal Choice reimbursement programs, by type of Personal Choice Network health care Provider. Please note that these programs may change from time to time, and the arrangements with particular Providers may be modified as new contracts are negotiated. If you have any questions about how your health care Provider is compensated, please speak with your healthcare provider directly or contact the Carrier’s Member Services Department.

Payment of Providers. Blue Shield HMO-G contracts with groups of Physicians to provide Services to Members. A fixed, monthly fee is paid to the groups of Physicians for each Member whose Personal Physician is in the group. This payment system, capitation, includes incentives to the group of Physicians to manage all Services provided to Members in an appropriate manner consistent with this Agreement. Therefore, the Personal Physician is responsible for providing Services, referring the Member to Plan Specialists and Providers and authorizing Hospital, Skilled Nursing Facility or other Services. If you want to know more about this payment system, contact Member Services at the number listed in the back of this booklet or talk to your Plan Provider.