PAYMENTS TO CONTRACTING EMERGENCY AND STABILIZATION HOSPITALS Sample Clauses

PAYMENTS TO CONTRACTING EMERGENCY AND STABILIZATION HOSPITALS. 24 A. Hospital Claims for Emergency Services and Outpatient Hospital Services 25 1. Upon approval of Hospital Claims for Emergency Services not resulting in an inpatient 26 admission and Outpatient Hospital Services, the Intermediary shall make reimbursements for these 27 claims at the following specified percentage of APR-DRG or the CalOptima Medi-Cal fee-for-service 28 rates, less the required co-payments to be collected by CONTRACTOR. 29 30 31 Service Contracting 32 Medical 100% 75% 45% 34 2. Required co-payments to be collected by CONTRACTOR for these services are as follows: 35 a. For emergency department visits CONTRACTOR shall collect a three hundred dollar 36 ($300) co-payment from MSN Enrollees; provided, however, if the MSN Enrollee is admitted directly 37 // 1 from the Emergency Room to CONTRACTOR’s facility or lower level of care, including Recuperative 2 Care, the co-payment for the emergency department visit shall be waived. 3 b. For Outpatient Hospital Services, including hospital based surgical center services and 4 physical and occupational therapy services as may be authorized by the CCU as Post Stabilization
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PAYMENTS TO CONTRACTING EMERGENCY AND STABILIZATION HOSPITALS. A. Hospital Claims for Emergency Services and Outpatient Hospital Services 1. Upon approval of Hospital Claims for Emergency Services not resulting in an inpatient admission and Outpatient Hospital Services, the Intermediary shall make reimbursements for these claims at the following specified percentage of APR-DRG or the CalOptima Medi-Cal fee-for-service rates, less the required co-payments to be collected by CONTRACTOR. Service Contracting Hospitals Contracting ED Hospitals Non-Contracting Hospitals Medical 100% 75% 45% follows: 2. Required co-payments to be collected by CONTRACTOR for these services are as a. For emergency department visits CONTRACTOR shall collect a three hundred
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