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Provider Payments Sample Clauses

Provider PaymentsThe state will establish and implement the necessary processes for ensuring accurate encounter payments to providers entitled to the prospective payment services (PPS) rate (e.g., certain FQHCs and RHCs) or the all-inclusive rate (e.g., certain Indian Health providers).
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Provider Payments. 11.1 Notification of the Provider Payment Schedule for each payment plan will be provided to you by the DentiCare provider portal, or by email. 11.2 Provider payments will be in monthly disbursement cycles including payment plans with a frequency of weekly or fortnightly debits, which will be aggregated and rounded to the monthly disbursement amount. 11.3 Payments to you, as nominated by you, will be made on one of the following payment cycles: 11.3.1 the 1st day of each month, or 11.3.2 the 15th day of each month, or 11.3.3 a combination of the 1st day of each month and the 15th day of each month. 11.4 Provider payments will be made when up to a 15 day period has elapsed between a scheduled payment plan debit date and a scheduled payment plan payment credit date. 11.5 Upon each payment to you, provider payment remittance advice will be provided by the DentiCare provider portal by, or email. 11.6 In the event a scheduled provider payment falls on a non-banking day the payment will reschedule for the immediate next banking day. 11.7 In the event DentiCare overpays you for any reason (i.e. service or product not provided, technical error, etc) you are required to notify DentiCare and an overpayment correction notice will be issued to you and you authorise DentiCare to direct debit the relative funds from your bank account linked to your DentiCare provider account.
Provider Payments. 12.1 Notification of the Provider Payment Schedule for each Payment Plan, and of any changes to the Payment Plan schedule, will be provided to you by the Portal, or by email. 12.2 Provider Payments will be in monthly disbursement cycles including Payment Plans with a frequency of weekly or fortnightly debits, which will be aggregated and rounded to the monthly disbursement amount. 12.3 Payments to you, as nominated by you, will be made on one of the following payment cycles: 12.3.1 the 1st day of each month, or‌ 12.3.2 the 15th day of each month, or
Provider PaymentsThe Department will determine Pilot care management payments and document them in the Department’s Healthy Opportunities Pilot Payment Protocol.
Provider Payments. $500 per Calendar Day beginning on or after September 1, 2022
Provider Payments. (1) The MCO shall submit medical provider bills electronically to the Bureau within seven (7) Business Days from the MCO's provider bill Receipt Date. The Bureau shall review all bills for allowed conditions and allowed claims and shall pay the MCO for allowed payments after receipt of a proper invoice and after a final adjudication permitting payment for the claim. The Bureau shall make Electronic Fund Transfer ("EFT") to the MCO within seven (7) Business Days after receipt of a proper invoice and after a final adjudication permitting payment for the claim. The MCO shall pay the provider within seven (7) Business Days from receipt of the EFT. The MCO shall pay interest to the Bureau at the rate established by the Office of Budget and Management, if the provider is not paid within thirty (30) days of receipt of the EFT from the Bureau. (2) The MCO shall retrieve electronic bills from the Bureau's World Wide Web site (www.xxxxxxx.xxx) xx later than 5:00 P.M. the next Business Day after the bills are placed in the MCO's directory by the Bureau. (3) The MCO shall pay provider bills in accordance with Rules 4123-6-10, 4123-6-11, and 4123-6-12 of the Ohio Administrative Code. However, if the MCO utilizes a leased provider network to fulfill the requirements of Section 1B. of this Agreement, the MCO shall not apply the discounted payment rates of the leased network to its payments to any provider within that network without first obtaining the signed written consent of the provider. (4) Not later than March 1, 1999, the MCO shall have and use a system that tracks the status of provider bills at any stage of the bill adjudication process. Such a system must allow the MCO to respond to inquiries by authorized parties and to the Bureau as to the disposition of a bill xxx the expected payment date of a bill. Xxe Bureau may require the MCO to issue reports to the Bureau and/or medical providers on the status of payments to providers. (5) The MCO shall educate providers, both in-state and out-of-state, on correct billing procedures and the MCO's prior authorization methods. (6) Following termination of this Agreement the Bureau shall reimburse the MCO for providers' services only if invoices are submitted within sixty (60) days of the termination date and only if such payment is not subject to deduction.
Provider Payments. Providers who deliver services to Members attributed to a Pilot ACO will continue to be paid in the same manner as providers who deliver services to PCC Plan enrollees, including from MassHealth’s managed behavioral health vendor. Pilot ACOs will be accountable for total cost of care through a retrospective reconciliation process, as further detailed in Attachment L.
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Provider Payments a. The PHP shall update providers reimbursements, consistent with rate floor requirements, to reflect Department defined COVID-19 related fee schedule changes as defined in the Contract. b. Effective on July 1, 2021 and until such time as the Department provides notice by publication of a Special Medicaid Bulletin of an end date for these rates, the PHP shall pay the Medical Home Fees to AMH Tiers 1 – 3 practices: i. $2.00 PMPM for Tier 1 practices, ii. $5.00 PMPM for Members not in the aged, blind and disabled eligibility category for Tier 2 and 3 practices, iii. $10.00 PMPM for Members in the aged, blind and disabled eligibility category for Tier 2 and 3 practices (consistent with Carolina ACCESS II in the Medicaid Fee-for-Service program), and iv. $67.82 PMPM for Members assigned to XXXX as AMH/PCP. c. For providers without a rate floor requirement, the PHP shall adjust negotiated provider reimbursement rates by an amount no less than the associated dollar change in the fee schedule made by the Department in the fee-for-service program in response to COVID-19.
Provider Payments. 12.1 Notification of the Provider Payment Schedule for each Payment Plan, and of any changes to the Payment Plan schedule, will be provided to you by the Portal, or by email. 12.2 Provider Payments subject to DentiCare Plus and or DentiCare Plus combined with DentiCare Connect will be in monthly disbursement cycles including Payment Plans with a frequency of weekly or fortnightly debits, which will be aggregated and rounded to the monthly disbursement amount. 12.3 Payments to you subject to Clause 12.2, as nominated by you, will be made on one of the following payment cycles: 12.3.1 the 1st day of each month, or 12.3.2 the 15th day of each month, or
Provider Payments ii. All VBP arrangements must be aligned with the PIHP Quality Strategy and related measures. iii. The PIHP shall re-submit contract templates to the Department for review at least ninety (90) Calendar Days before use in the market when any new VBP arrangements (excluding to AMHs, which is covered in Section IV.H.4. Provider Payments), or changes to VBP arrangements, are added. c. The Department may set minimum targets for VBP contracting starting in Contract Year 2, and implement withholds associated with these targets. Targets will be published at least six (6) months prior to the Contract Year in which they take effect. d. The PIHP shall have IT infrastructure and data analytic capabilities to support the Department’s vision in moving toward VBP, including having systems that can support alternative payment arrangement models which require data-sharing across different provider types, care settings and locations. These systems must have mechanisms to measure quality and costs across attributed populations, share actionable administrative and clinical data with providers in these VBP arrangements, and process payments to providers based on the terms of the contract. e. Following the end of Contract Year 1, the PIHP shall complete an annual VBP Assessment, in a format to be determined by the Department, based on the categories developed by HCP-LAN. i. The Department shall use the VBP Assessment to demonstrate details about VBP contracts and compare documented progress to the PIHP’s final VBP Strategy on an annual basis. ii. The PIHP shall report the initial results of its VBP Assessment focused on VBP contracts in place to date within ninety (90) days of the end of the Contract Year 1. iii. As long as the VBP Assessment clearly state it applies to the PIHP, VBP Assessment may apply to other PIHP operations, including without limitation the BH I/DD Tailored Plan contract. iv. The PIHP shall update the VBP Assessment on an annual basis, within ninety (90) Calendar Days of the end of each contract year. f. To ensure the PIHP’s response aligns with the Department’s strategy and goals, the PIHP shall develop a PIHP VBP Strategy for Contract Years 1-3, in alignment with the Department’s short- and long-term goals to shift from a fee for service system to VBP. i. The PIHP VBP Strategy must be submitted to the Department due upon request but no sooner than one hundred eighty (180) Calendar Days after Contract Execution. ii. As long as the VBP Strategy clearly sta...
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