Reconciliation Schedule Sample Clauses

Reconciliation Schedule. The Reconciliation Schedule pursuant to Section 1.4 of this Agreement.

Reconciliation Schedule. The Agency shall provide utilization data and conduct annual reconciliations in accordance with the following schedule: Dates of Service 09/1209 – 08/1512 Utilization Data CD Schedule Annual Reconciliation 09/1209 - 02/130 09/130 093/1230 - 08/130 0310/141 10/141 09/130 - 02/141 09/141 09/133/141 - 08/141 03/1510/152 10/152 09/141 - 02/152 09/125 03/1509/14 2- 08/152 03/1610/163 10/163 E. Annual Reconciliations for Dates of Services Prior to September 1, 2013 (Contract Year 1) The Agency shall conduct annual cost reconciliations to determine the amount of cost savings achieved by the Health Plan for the dates of service in the period being reconciled. The Agency shall calculate the aggregate amount of actual payments made on behalf of the Health Plan’s enrollees. Only payments for covered services for dates of service within the reconciliation period and paid within one (1) year after the last date of service in the reconciliation period will be included. This allows for a complete payment of all claims for the reconciliation period. The Agency will make the necessary adjustments to any amounts owed to or payable by the Agency based on the results of the annual reconciliation. 1. The reconciliation of Reform populations will be separate from non-Reform populations. For reconciliations for Reform populations, the Agency shall adjust the actual claim costs to $550,000 (benefit maximum) for covered services provided to non-pregnant adult enrollees in excess of $550,000. The Health Plan shall not be held liable for claims costs of over $550,000 for non-pregnant adult enrollees. 2. If the aggregate adjusted actual payments for the reconciliation period are less than the aggregated PCCB for the reconciliation period, the resulting amount is the savings pool. If the amount of the savings pool exceeds the total administrative allocation due to the Health Plan for the dates of service included in the reconciliation, the Agency shall allocate one hundred percent (100%) of the difference between the savings pool and the total administrative allocation to the Health Plan. 3. If the savings pool is less than the administrative allocation, the Health Plan will refund the difference between the savings pool and the total administrative allocation due for the time period included in the reconciliation. However, the maximum amount the Health Plan shall refund is fifty percent (50%) of the total administrative allocation due. 4. If the administrative allocation has been gar...

Reconciliation Schedule. The Agent shall have received a Reconciliation Schedule, substantially in the form of Exhibit C attached hereto, signed by the Responsible Officer of the Borrower.