When Contractor is Required to Make PIPs. The contractor shall make PIPs to a participating (network provider), qualifying hospital when the average monthly payment from the contractor to the hospital is at least $100,000 for the most recent six-month period excluding outliers. An outlier is defined as a single admission for which the payment to the hospital exceeds $100,000. It should be noted that outlier claims paid are included in the establishment of the monthly PIPs and the reconciliation of the PIPs.
Appears in 4 contracts
Samples: Agreement to Provide Hmo Services (Amerigroup Corp), Agreement to Provide Hmo Services (Amerigroup Corp), Contract to Provide Services (Centene Corp)
