AMENDMENT #1Wellcare Health Plans, Inc. • January 12th, 2007 • Hospital & medical service plans
THIS AMENDMENT #1 is made and entered into this ^ I day of November, by and between Florida Healthy Kids Corporation (PHKC) and HEALTHEASE OF FLORIDA, INC. AND WELLCARE HMO, INC. hereinafter collectively referred to as INSURER.
APPENDIX X [Amendment Number 1]Non Covered Services • January 12th, 2007 • Wellcare Health Plans, Inc. • Hospital & medical service plans
PROVIDER AGREEMENT BETWEEN STATE OF OHIO DEPARTMENT OF JOB AND FAMILY SERVICES AND WELLCARE OF OHIO, INC. Amendment No. 2Provider Agreement • January 12th, 2007 • Wellcare Health Plans, Inc. • Hospital & medical service plans • Ohio
Pursuant to Article IX.A. the Provider Agreement between the State of Ohio, Department of Job and Family Services, (hereinafter referred to as "ODJFS") and WELLCARE OF OHIO, INC. (hereinafter referred to as "MCP") for the Covered Families and Children (hereinafter referred to as "CFC") population dated November 1, 2006, is hereby amended as follows:
PROVIDER AGREEMENT BETWEEN STATE OF OHIOProvider Agreement • January 12th, 2007 • Wellcare Health Plans, Inc. • Hospital & medical service plans • Ohio
TPL can be identified with two components: "cost-avoidance" and ''pay and chase" type actions. "Cost-avoidance" occurs when the State initially denies paying a claim because another payer is the primary payer. The State may then pay a residual portion of the charged amount. Only the residual portion of the claim will be included in the FFS data. The portion of the claim paid by another payer has been avoided and not included in reported claim payments. Participating MCPs are expected to pay in a similar fashion and therefore, no adjustment to the FFS data will be required.
