Capitated Services definition

Capitated Services means those covered services that a PHP agrees to provide for a capitation payment under contract with the Authority.

Capitated Services means those covered services that an MCE agrees to provide for a capitation payment under contract with the Authority.

Capitated Services means services rendered by a provider through a contract in which payments are based upon a fixed monthly dollar amount for each enrollee.

Examples of Capitated Services in a sentence

• Upon termination, Contractor, if offering a HMO, shall complete the processing of all claims for benefit payments under the QHP for Covered Services other than Capitated Services, and if offering a PPO, shall complete the processing of all medical claims for benefit payments under Contractor’s QHP for Covered Services rendered on or before the termination date.

• Beneficiaries enrolled in a Medi-Cal managed care plan will receive through the managed care delivery system Medi-Cal benefits as identified in Attachment N – Capitated Services List/Managed Care Benefit Package.

• SPDs mandatorily enrolled in any managed care program within the State will receive from the managed care program the benefits as identified in Attachment N – Capitated Services List/Managed Care Benefit Package.

• Upon termination, Contractor, if offering a DHMO, shall complete the processing of all claims for benefit payments under the QDP for Specialized Health Care Services other than Capitated Services, and if offering a DPPO, shall complete the processing of all dental claims for benefit payments under Contractor’s QDP for Specialized Health Care Services rendered on or before the termination date.

• Enrollment of an Oregon Health Plan (OHP) client, excluding the Health Plan New/Noncategorical client (HPN) and Children's Health Insurance Program (CHIP) clients in Prepaid Health Plans (PHPs) shall be mandatory unless exempted from enrollment by the Oregon Health Authority (Authority), or unless the OHP client resides in a Service Area where there is inadequate capacity to provide access to Capitated Services for all OHP clients through PHPs or Primary Care Managers (PCMs).

More Definitions of Capitated Services

Capitated Services means services rendered by a provider through a contract in which payment are based upon a fixed dollar amount for each member on a monthly basis.

Capitated Services means services paid through a fixed amount of money per patient per unit of time paid in advance for the delivery of health care services. The actual amount of money paid is determined by the ranges of services that are provided, the number of patients involved, and the period of time during which the services are provided.

Capitated Services means Contract Services for which (PACE Program) receives a capitated payment.

Capitated Services means those Covered Services that Contractor agrees to provide in the Statement of Work, Exhibit B, Part I through VI of this Contract, in exchange for a Capitation Payment.

Capitated Services means those covered services that an MCE agrees to provide for a capitation

Capitated Services means those Covered Services which are provided or arranged by Participating Providers in exchange for a fixed monthly payment per Enrollee.

Capitated Services means those Covered Services, which are the financial responsibility of (PACE Program) under the PHP Agreement. Except as otherwise provided in this MOU, (Sponsor) shall hold (PACE Program) solely responsible for payment for Capitated Services provided to Participants.