Capitation definition

Capitation means the reimbursement arrangement in which a fixed rate of payment per Enrollee per month is made to the Contractor for the performance of all of the Contractor’s duties and obligations pursuant to this Contract.

Capitation means a mechanism of payment in which a provider

Capitation means a uniform prepayment fee per Member per month, adjusted by age-sex, based on the Benefit Agreement issued to each Subscriber and the services due thereunder.

Examples of Capitation in a sentence

• Premium Revenue includes, but is not limited to, all monies paid by the Division to the Contractor for providing benefits and services as defined in the terms of the Contract and is inclusive of Capitation Payments, Capitation Premium Withhold amounts earned, Health Insurer Fee reimbursement, Risk Corridor adjustments, and any other Medicaid Managed Care Program Revenues, but is exclusive of any amounts received from DOM PBA.

• For each MLR Reporting Quarter and Year, the Contractor must submit to the Division a report which complies with the requirements that follow concerning Capitation Payments received and expenses related to CHIP Members [42 CFR 438.8(a)] (referred to hereafter as MLR Report).

• In any instance where the Division makes a retroactive change to the Capitation Payments for an MLR Reporting Year where the MLR Report has already been submitted to the Division, Contractor must re-calculate the MLR for all MLR Reporting Years affected by the change and submit a new MLR Report meeting the requirements of this section.

• The previously certified capitation rates and the documentation of their development were published in the following correspondence provided by Xxxxxxxx: • Calendar Year 2020 MyCare Ohio Capitation Rate Certification – Opt-In Capitation Rates, dated December 6, 2019 (Original) We have updated the capitation rates to include new and revised program adjustments not reflected in the Original certification.

• EOHHS will not factor Value-Added Service into its calculation of the Contractor’s Capitation Rate, meaning the Contractor is responsible for the cost of all Value-Added Services.

More Definitions of Capitation

Capitation or “Capitation Payment” means the HIPAA 820 Premium Payment paid to MCOs, PAHPs, PACE organizations, and the NEMT broker.

Capitation means a fixed per member, per month, payment or

Capitation means a method of compensating a

Capitation means a method of payment in which HMO or a health care provider receives a fixed amount of money each month for each enrolled Member, regardless of the amount of covered services used by the enrolled Member.

Capitation means the mandatory administration fee included in a membership category.

Capitation means a per Member fixed fee amount that may be paid by Wellmark on behalf of Account to certain health care providers each month for certain Covered Services that may be provided to a Member. The Capitation amount may change during the term of this Agreement in accordance with agreements between Wellmark and the providers regarding payment and the scope of capitated services.

Capitation means a method of compensating a physician or provider for arranging for or providing a defined set of covered health care services to certain enrollees for a specified period that is based on a predetermined payment per enrollee for the specified period, without regard to the quantity of services actually provided.