OHIO DEPARTMENT OF JOB AND FAMILY SERVICES OHIO MEDICAL ASSISTANCE PROVIDER AGREEMENT FOR MANAGED CARE PLAN CFC ELIGIBLE POPULATIONMedical Assistance Provider Agreement • March 14th, 2007 • Molina Healthcare 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.
OHIO DEPARTMENT OF JOB AND FAMILY SERVICES OHIO MEDICAL ASSISTANCE PROVIDER AGREEMENT FOR MANAGED CARE PLAN ABD ELIGIBLE POPULATIONMedical Assistance Provider Agreement • June 29th, 2007 • Wellcare Health Plans, Inc. • Hospital & medical service plans • Ohio
The following table shows the specified policy changes for which Mercer adjusted the SFY 2003 and SFY 2004 data. Mercer calculated the adjustments based on the "History of Policy Changes" document and other information supplied by the State.
