Common use of Service Request Clause in Contracts

Service Request. An Enrollee‘s oral or written request of the Contractor to authorize and pay for a benefit or service. This request for services shall include Covered Services as referenced in Appendix A and defined in Appendix B. Service Requests may also be referred to as: requests for Covered Services, requests for coverage decisions or requests for organization determinations. 1. 102. State — The Commonwealth of Massachusetts. 1. 103. State Fair Hearing — An Appeal filed for Medicaid services with the State Board of Hearings. 1. 104. Third Party Liability (TPL) Indicator Form — Form supplied to inpatient hospitals by EOHHS that is used to notify the Contractor when the hospital discovers that an Enrollee has comprehensive insurance coverage other than Medicare or Medicaid. 1. 105. Total Capitation Rate Revenue — The sum of the monthly capitation payments for Demonstration Year 1 (reflecting coverage of Medicare Parts A/B services, Medicare Part D services and Medicaid services, pursuant to Appendix A and defined in Appendix B of this Contract) including:

Service Request. An Enrollee‘s Enrollee’s oral or written request of the Contractor to authorize and pay for a benefit or service. This request for services shall include Covered Services as referenced in Appendix A and defined in Appendix B. Service Requests may also be referred to as: requests for Covered Services, requests for coverage decisions or requests for organization determinations. 1. 102104. State — The Commonwealth of Massachusetts. 1. 103105. State Fair Hearing — An Appeal filed for Medicaid services with the State Board of Hearings. 1. 1041.106. Third Party Liability (TPL) Indicator Form — Form supplied to inpatient hospitals by EOHHS that is used to notify the Contractor when the hospital discovers that an Enrollee has comprehensive insurance coverage other than Medicare or Medicaid. 1. 105107. Total Capitation Rate Revenue — The sum of the monthly capitation payments for Demonstration Year 1 (reflecting coverage of Medicare Parts A/B services, Medicare Part D services and Medicaid services, pursuant to Appendix A and defined in Appendix B of this Contract) including:

Service Request. An Enrollee‘s Enrollee’s oral or written request of the Contractor to authorize and pay for a benefit or service. This request for services shall include Covered Services as referenced in Appendix A and defined in Appendix B. Service Requests may also be referred to as: requests for Covered Services, requests for coverage decisions or requests for organization determinations. 1. 102. State — The Commonwealth of Massachusetts. 1. 103. State Fair Hearing — An Appeal filed for Medicaid services with the State Board of Hearings. 1. 104. Third Party Liability (TPL) Indicator Form — Form supplied to inpatient hospitals by EOHHS that is used to notify the Contractor when the hospital discovers that an Enrollee has comprehensive insurance coverage other than Medicare or Medicaid. 1. 105. Total Capitation Rate Revenue — The sum of the monthly capitation payments for Demonstration Year 1 (reflecting coverage of Medicare Parts A/B services, Medicare Part D services and Medicaid services, pursuant to Appendix A and defined in Appendix B of this Contract) including: