Payment to Providers for Serving Dual Eligible Members. The Contractor shall coordinate benefits for Dual Eligible Members by paying the lesser amount of: A. The Contractor’s allowed amount minus the Medicare payment, or B. The Medicare co-insurance and deductible up to Contractor’s allowed amount. In the event that Medicaid does not have a price for codes included on a crossover claim then the entire Medicare coinsurance and deductible shall be paid by the Contractor. The Contractor shall further assist Dual Eligible Members in coordination of benefits required under Section 4.3 “Delegations of Authority.”
Appears in 4 contracts
Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract, Medicaid Managed Care Contract
Payment to Providers for Serving Dual Eligible Members. The Contractor shall coordinate benefits for Dual Eligible Members by paying the lesser amount of:
A. The Contractor’s allowed amount minus the Medicare payment, or
B. The Medicare co-insurance and deductible up to Contractor’s allowed amount. In the event that Medicaid does not have a price for codes included on a crossover claim then the entire Medicare coinsurance and deductible shall be paid by the Contractor. The Contractor shall further assist Dual Eligible Members in coordination of benefits required under Section 4.3 “Delegations of Authority.”
Appears in 1 contract
Samples: Managed Care Contract (Wellcare Health Plans, Inc.)
