Provider Compensation. The Contractor shall ensure that no payment is made to a network provider other than payment the Contractor makes for services covered under this Contract, except when these payments are specifically required to be made by the state in Title XIX of the Act, in 42 Code of Federal Regulations in chapter IV, or when the state agency makes direct payments to network providers for graduate medical education costs approved under the State Plan. (42 C.F.R. § 438.60.)
Provider Compensation. Provider shall be compensated for the provision of Covered Services to Members based on the compensation system set forth in Exhibit A of this Agreement, as may be amended from time to time.
Provider Compensation. A. Reimbursement Pricing -- 30-
Provider Compensation. The Department shall ensure that no payment is made to a network provider other than by the Contractor for services covered under this agreement, except when these payments are specifically required to be made by the Department in Title XIX of the Act, in 42 CFR chapter IV. (42 C.F.R. § 438.60.)
Provider Compensation. A. Plan compensates EAP Providers through an agreement by which they are paid a fixed amount of money based on hours worked, number of Members seen, or number of sessions provided. Providers are compensated within thirty (30) days after a claim is received.
B. Plan does not distribute financial bonuses or use any other incentive program to compensate its EAP Providers other than the methods of compensation defined above.
Provider Compensation. Members may request information about Plan’s EAP Provider reimbursement policies and procedures by contacting Plan’s Manager, Provider Relations, at 0-000-000-0000 or the Member's EAP Provider.
Provider Compensation. As compensation for the services rendered at the Practice Sites, Provider shall receive compensation as set forth on Appendix "A", attached hereto and made a part hereof ("Provider Compensation"). With respect to any partial calendar years during which this Agreement is in effect, Provider Compensation shall be prorated according to the number of calendar days actually elapsed during such partial calendar year.
Provider Compensation a. The MCO shall comply with HCFA's Physician Incentive Plan (PIP) requirements in 42 CFR 434.70. The MCO may operate a PIP only if:
1. no specific payment can be made directly or indirectly under a PIP to a physician or physician group as an inducement to reduce or limit medically necessary services furnished to an individual Member; and
2. the stop-loss protection, Member survey, and disclosure requirements of 42 C.F.R. 417.479 are met.
b. The MCO shall disclose to the DEPARTMENT the following information on PIPs in sufficient detail to determine whether the incentive plan complies with the regulatory requirements of 42 CFR 417.479. The disclosure must contain:
1. Whether services not furnished by the physician or physician group are covered by the PIP. If only the services furnished by the physician or physician group are covered by the incentive plan, disclosure of other aspects of the plan need not be made.
2. The type of incentive arrangement (i.e. withhold, bonus, capitation).
3. If the incentive plan involves a withhold or bonus, the percent of the withhold or bonus.
4. Proof that the physician or physician group has adequate stop-loss protection, including the amount and type of stop-loss protection.
5. The panel size and, if patients are pooled, the method used.
6. In the case of those MCOs that are required by 42 C.F.R. 417.479 provision to conduct Member surveys, the survey results.
c. The MCO shall disclose this information to the DEPARTMENT (1) prior to approval of its contract as required by federal regulation and (2) upon the contract anniversary or renewal effective date. The MCO shall provide the capitation data required (see (6) above) for the previous contract year to the DEPARTMENT three (3) months after the end of the contract year. The MCO will provide to the Member upon request information regarding whether the MCO uses a physician incentive plan that affects the use of referral services, the type of incentive arrangement, whether stop-loss protection is provided, and the survey results of any Member survey conducted. See Appendix J for the applicable regulations and disclosure forms.
d. The DEPARTMENT may impose Class C sanctions pursuant to Section 7.05 for failure to comply with 42 C.F.R. 417.479
Provider Compensation. Provide compensation to the Provider upon receipt of a complete and correct invoice as described in Section III-S below at a rate of per hour for each student. An instructional session shall be minutes in length. In no event shall the total cost per year for any individual student exceed the state-approved SES per pupil allocation ($ 1,424.00 during 2008-2009). SAMPLE
Provider Compensation. The MCO shall comply with CMS's Physician Incentive Plan (PIP) requirements in 42 CFR 422.208 and 42 CFR 422.210. The MCO may operate a PIP only if:
