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Risk Stratification Sample Clauses

Risk Stratification. 2.6.1.1. The STAR+PLUS MMP will develop and implement a risk stratification process that uses a combination of predictive-modeling software, assessment tools, referrals, administrative Claims data, and other sources of information as appropriate that will consider Enrollees’ physical and behavioral health, substance use, and LTSS needs and specifically, any Special Health Care Needs of the Enrollees. 2.6.1.2. The STAR+PLUS MMP will stratify Enrollees in two (2) risk levels, with level 1 the highest risk and level 2 moderate and lower risk Enrollees. 2.6.1.2.1. These levels of stratification should be based on: 2.6.1.2.1.1. Level 1 Enrollees: Highest level of risk/utilization includes HCBS STAR+PLUS Waiver, Nursing Facility, individuals with SPMI, and other Enrollees with complex medical needs. 2.6.1.2.1.2. Level 2 Enrollees: Lower level of risk/utilization includes Enrollees receiving LTSS for PAS or day activity and health services (DAHS and Enrollees with non-SPMI behavioral health issues).
Risk StratificationContractor will use an approved health risk stratification mechanism or algorithm to identify new Enrollees with high risk and more complex health care needs. The health risk stratification shall be conducted in accordance applicable DPL(s) as indicated in Section 2.1.5 2.8.1.1. Contractor shall use the following data sources to identify an Enrollees’ risk level. 2.8.1.1.1. Medicare utilization data, including Medicare Parts A, B, and D. 2.8.1.1.2. Medi-Cal utilization data, including IHSS, MSSP, SNF, and Behavioral Health pharmacy data. 2.8.1.1.3. Results of previously administered assessments. 2.8.1.1.4. Other population- and individual-based tools.
Risk Stratification. An informed estimate of the probability of a person succumbing to a disease or benefiting from a treatment for that disease
Risk Stratification. The STAR+PLUS MMP will develop and implement a risk stratification process that uses a combination of predictive- modeling software, assessment tools, referrals, administrative Claims data, and other sources of information as appropriate that will consider Enrollees’ physical and behavioral health, substance use, and LTSS needs.
Risk Stratification. 1.8.1 In the event DCFS is not in agreement with the risk level determination made by Contractor for a DCFS Youth in Care Enrollee, Contractor will work collaboratively with the Department and DCFS to resolve the disagreement and ensure that the best interest and needs of the DCFS Youth in Care Enrollee are met.
Risk StratificationThe act or process of dividing Tenncare members into different levels of need based on their health risk. For TennCare’s Population Health program, risk stratification is accomplished by predictive modeling which is based on claims, pharmacy, lab and other data. Information from health risk assessments is also used to identify member’s risk level. Through this process members are identified for one of three health risk stratification levels. Level Zero is wellness, Level One is low to moderate health risk, and Level Two is the top three percent or the sickest of the sick.
Risk StratificationThe Contractor shall implement a risk stratification process that meets the requirements of this Section. a. The Contractor shall predictably model, stratify and define the Enrollee population into risk categories, with at least one method to calculate a risk score for each Enrollee. The methodology shall: 1) At a minimum, utilizes claims and pharmacy data, laboratory data, referrals, data related to utilization management, and care needs assessment results to: 2) Assess the Enrollee’s risk for high cost, high utilization, admission, re-admission, or other adverse health outcomes; b. The Contractor shall document and detail the approach (e.g., use of specific risk assessment tool) and criteria employed to define and assign the risk categories of the population and provide such information to EOHHS upon request. c. The Contractor shall utilize the stratification of Enrollees to inform its development and use of appropriate intervention approaches (such as Care Management) and maximize the impact of the services provided to Enrollees. d. The Contractor shall stratify new Enrollees within 60 days of enrollment and re-stratify the all Enrollees at a minimum bi-annually.
Risk Stratification. 2.6.1.1. The STAR+PLUS MMP will develop and implement a risk stratification process that uses a combination of predictive- modeling software, assessment tools, referrals, administrative Claims data, and other sources of information as appropriate that will consider Enrollees’ physical and behavioral health, substance use, and LTSS needs. 2.6.1.2. The STAR+PLUS MMP will stratify Enrollees into two (2) risk levels, with level 1 the highest risk and level 2 moderate and lower risk Enrollees. 2.6.1.2.1. These levels of stratification should be based on: 2.6.1.2.1.1. Xxxxx 0 Xxxxxxxxx: Xxxxxxx level of risk/utilization includes HCBS STAR+PLUS Waiver, Nursing Facility (except for nursing facility Enrollees listed under Level 3), individuals with SPMI, and other Enrollees with complex medical needs. 2.6.1.2.1.2. Level 2 Enrollees: Lower level of risk/utilization includes Enrollees receiving LTSS for personal assistance services or day activity and health services (PAS and DAHSand Enrollees with non- SPMI behavioral health issues.

Related to Risk Stratification

  • Investment Analysis and Implementation In carrying out its obligations under Section 1 hereof, the Advisor shall: (a) supervise all aspects of the operations of the Funds; (b) obtain and evaluate pertinent information about significant developments and economic, statistical and financial data, domestic, foreign or otherwise, whether affecting the economy generally or the Funds, and whether concerning the individual issuers whose securities are included in the assets of the Funds or the activities in which such issuers engage, or with respect to securities which the Advisor considers desirable for inclusion in the Funds' assets; (c) determine which issuers and securities shall be represented in the Funds' investment portfolios and regularly report thereon to the Board of Trustees; (d) formulate and implement continuing programs for the purchases and sales of the securities of such issuers and regularly report thereon to the Board of Trustees; and (e) take, on behalf of the Trust and the Funds, all actions which appear to the Trust and the Funds necessary to carry into effect such purchase and sale programs and supervisory functions as aforesaid, including but not limited to the placing of orders for the purchase and sale of securities for the Funds.

  • Attachment A, Scope of Services The scope of services is amended as follows:

  • Investment Analysis and Commentary The Subadviser will provide quarterly performance analysis and market commentary (the “Investment Report”) during the term of this Agreement. The Investment Reports are due within 10 days after the end of each quarter. In addition, interim Investment Reports shall be issued at such times as may be mutually agreed upon by the Adviser and Subadviser; provided however, that any such interim Investment Report will be due within 10 days of the end of the month in which such agreement is reached between the Adviser and Subadviser. The subject of each Investment Report shall be mutually agreed upon. The Adviser is freely able to publicly distribute the Investment Report.

  • Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time.

  • Certificate of Analysis Seller shall provide a certificate of analysis and other documents as defined in the Quality Agreement for any Product to be released hereunder, in a form in accordance with the cGMPs and all other applicable Regulatory Requirements and Product Specifications and as shall be agreed upon by the parties. For any batch that initially failed to meet any Product Specification, the certificate of analysis shall document the exception. Products that do not meet dissolution specifications at USP Stage I and II testing shall not be accepted by Buyer (and such requirement shall be included in the Product Specifications/Quality Manual).

  • Certification as to Authorized Persons The Secretary or Assistant Secretary of the Fund will at all times maintain on file with the Bank his or her certification to the Bank, in such form as may be acceptable to the Bank, of (i) the names and signatures of the Authorized Persons and (ii) the names of the members of the Board, it being understood that upon the occurrence of any change in the information set forth in the most recent certification on file (including without limitation any person named in the most recent certification who is no longer an Authorized Person as designated therein), the Secretary or Assistant Secretary of the Fund will sign a new or amended certification setting forth the change and the new, additional or omitted names or signatures. The Bank will be entitled to rely and act upon any Officers' Certificate given to it by the Fund which has been signed by Authorized Persons named in the most recent certification received by the Bank.

  • Service Description 2.1 General

  • Service Descriptions Credit Card processing services: Global Direct’s actions to the appropriate card associations and/or issuers (e.g., Visa, MasterCard, Diners, Discover); settlement; dispute resolution with cardholders’ banks; and transaction-related reporting, statements and products. Debit/ATM Processing Services: Global Direct has connected to the following debit card networks (“Networks”): Accel, AFFN, Interlink, MAC, Maestro, NYCE, Pulse, Star, and Tyme. Global Direct will provide Merchant with the ability to access the Networks that Global Direct has connected to for the purpose of authorizing debit card transactions at the point of sale from cards issued by the members of the respective Networks. Global Direct will provide connection to such Networks, terminal applications, settlement and reporting activities. EBT Transaction Processing Services: Global Direct offers electronic interfaces to Electronic Benefits Transfer (“EBT”) networks for the processing of cash payments or credits to or for the benefit of benefit recipients (“Recipients”). Global Direct will provide settlement and switching services for various Point of Sale transactions initiated through Merchant for the authorization of the issuance of the United States Department of Agriculture, Food and Nutrition Services (“FNS”) food stamp benefits (“FS Benefits”) and/or government delivered cash assistance benefits (“Cash Benefits, ”with FS Benefits, “Benefits”) to Recipients through the use of a state-issued card (“EBT Card”). With respect to Visa and MasterCard products, Merchant agrees to pay and Merchant's account(s) will be charged pursuant to Section 5 of this Agreement for any additional fees incurred as a result of Merchant's subsequent acceptance of transactions with any Visa or MasterCard product that it has not elected to accept.

  • ODUF Packing Specifications 6.3.1 A pack will contain a minimum of one message record or a maximum of 99,999 message records plus a pack header record and a pack trailer record. One transmission can contain a maximum of 99 packs and a minimum of one pack.

  • GENERAL SERVICE DESCRIPTION Service Provider currently provides active medical, pharmacy(Rx) and dental administration for coverages provided through Empire and Anthem (medical), Medco(Rx), MetLife(dental) and SHPS (FSA) (Empire, Anthem, Medco, MetLife and SHPS collectively, the “Vendors”) for its U.S. Active, Salaried, Eligible Employees (“Covered Employees”). Service Provider shall keep the current contracts with the Vendors and the ITT CORPORATION SALARIED MEDICAL AND DENTAL PLAN (PLAN NUMBER 502 EIN 00-0000000) and the ITT Salaried Medical Plan and Salaried Dental Plan General Plan Terms (collectively, the “Plans”) and all coverage thereunder in full force through December 31, 2011 for Service Recipient’s Covered Employees. All claims of Service Recipient’s Covered Employees made under the Plans and incurred on or prior to December 31, 2011 the (“2011 Plan Year”) will be adjudicated in accordance with the current contract and Service Provider will continue to take such actions on behalf of Service Recipient’s Covered Employees as if such employees are employees of Service Provider. All medical, dental, pharmacy and FSA claims of Service Recipient’s Covered Employees made under the Plans (the “Claims”) will be paid by the Vendors on behalf of the Service Provider. Service Recipient will pay Service Provider for coverage based on 2011 budget premium rates previously set for the calendar year 2011 and described in the “Pricing” section below. Service Recipient will pay Service Provider monthly premium payments for this service, for any full or partial months, based on actual enrollment for the months covered post-spin using enrollments as of the first (1st) calendar day of the month, commencing on the day after the Distribution Date. Service Recipient will prepare and deliver to Service Provider a monthly self xxxx containing cost breakdown by business unit and plan tier as set forth on Attachment A, within five (5) Business Days after the beginning of each calendar month. The Service Recipient will be required to pay the Service Provider the monthly premium payments within ten (10) Business Days after the beginning of each calendar month. A detailed listing of Service Recipient’s employees covered, including the Plans and enrollment tier in which they are enrolled, will be made available to Service Provider upon its reasonable request. Service Provider will retain responsibility for executing funding of Claim payments and eligibility management with Vendors through December 31, 2013. Service Provider will conduct a Headcount True-Up (as defined below) of the monthly premiums and establish an Incurred But Not Reported (“IBNR”) claims reserve for Claims incurred prior to December 31, 2011 date, but paid after that date, and conduct a reconciliation of such reserve. See “Headcount True-Up” and “IBNR Reconciliation” sections under Additional Pricing for details.