Capitated basis definition

Capitated basis means fixed per member per month payment or percentage of premium payment wherein the provider assumes the full risk for the cost of contracted services without regard to the type, value, or frequency of services provided. For purposes of this definition, capitated basis includes the cost associated with operating staff model facilities.
Sample 1Sample 2Sample 3
Capitated basis means fixed per-member, per-month payments or percentage-of-premium payments pursuant to which the provider assumes full risk for the cost of contracted services without regard to the type, value or frequency of services provided. For purposes of this definition, capitated basis includes the cost associated with operating staff model facilities.[PL 1991, c. 709, §2 (NEW).]
Sample 1Sample 2Sample 3
Capitated basis means fixed per member per month payment or percentage of premium payment wherein the provider assumes the full risk for the cost of contracted services without regard to the type, value or
Sample 1Sample 2

Examples of Capitated basis in a sentence

  • The Contractor shall comply with Capitated contract rules established by PRICO, in accordance with Normative Letter CA-I-2-1232-91 (Attachment 13 to this Contract), which provides that every contract based on a Capitated payment arrangement prohibits the Provider from in turn subcontracting on a Capitated basis.

  • A distinct set of services provided to an Enrollee in a face-to-face setting on the dates that the services were delivered, regardless of whether the Provider is paid on a Fee-for-Service or Capitated basis.

  • Encounter Data for all items and services provided by PROVIDER, even if PROVIDER is reimbursed on a Capitated basis, must be submitted with the paid field indicating the allowed amount, even if the amount is zero (0) dollars.

  • Encounter Data for all items and services provided by Network Providers, even if the Network Provider is reimbursed on a Capitated basis, must be submitted with the paid field indicating the allowed amount, even if the amount is zero (0) dollars.


More Definitions of Capitated basis

Capitated basis. MEANS A FIXED MEMBER PER MONTH PAYMENT OR FIXED PERCENTAGE OF PREMIUM PAYMENT WHERE THE PROVIDER OR
Sample 1Sample 2
Capitated basis means fixed per member per month payment or percentage of
Sample 1Sample 2

Related to Capitated basis

  • Loss Adjustment Expense means costs and expenses incurred by the Company in connection with the investigation, appraisal, adjustment, settlement, litigation, defense or appeal of a specific claim or loss, or alleged loss, including but not limited to: