Common use of Provider Reimbursement Clause in Contracts

Provider Reimbursement. The MCO must pay for all Medically Necessary Covered Services provided to all Members for whom the MCO is paid a capitation. A STAR+PLUS MCO must also pay for all Functionally Necessary Covered Services provided to all Members for whom the MCO is paid a capitation. The MCO must ensure that claims payment is timely and accurate as described in Section 8.1.

Provider Reimbursement. The MCO must pay for all Medically Necessary Covered Services provided to all Members for whom the MCO is paid a capitationMembers. A STAR+PLUS MCO must also pay for all Functionally Necessary Covered Services provided to all Members for whom Members. The MCO's Network Provider Agreement must include a complete description of the MCO is paid a capitationpayment methodology or amount, as described in Uniform Managed Care Manual Chapter 8. 1. The MCO must ensure that claims payment is timely and accurate as described in Section 8.18.1.18.5, "Claims Processing Requirements," and UMCM Chapters 2.0 through 2.