Capitation Services definition

Capitation Services means all CALIFORNIACARE Covered Medical Services which are not otherwise defined in this Agreement or in the Division of Financial Responsibilities (Exhibit A-1 hereto) as Non-Capitated Services.

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Capitation Services means those services listed in Section 2.1 of this Agreement, including in lieu of services, for which the Contractor receives a Capitation Payment from the Department.

Capitation Services means all AIM Covered Medical Services which are not otherwise designated as Insured Services or the responsibility of BLUE CROSS, in the Division of Financial Responsibilities under Exhibit A(1).

Examples of Capitation Services in a sentence

To accept the monthly Capitation payment from BLUE CROSS as payment in full for Capitation Services (including all Referral Services) provided or arranged hereunder, and not to seek additional payments or compensation from Members for Covered Medical Services.
This limitation shall not prevent BLUE CROSS from initiating such procedures as the representative of its Members, or PARTICIPATING MEDICAL GROUP from initiating such procedures on behalf of Members for whom they have assumed responsibility for the provision of Capitation Services, and for arranging Non-Capitated Services provided that in any such case BLUE CROSS or PARTICIPATING MEDICAL GROUP, respectively, shall be considered the initiating party for the purposes of Section 14.03 hereof.
PARTICIPATING MEDICAL GROUP shall be solely responsible to the Member for treatment and medical care with respect to the provision of Capitation Services and arrangements for Non-Capitated Services.
To use a referral request process by which Capitation Services are to be rendered by Health Professionals other than the Member’s Primary Care Physician, including PARTICIPATING MEDICAL GROUP Physicians or other Health Professionals who do not belong to PARTICIPATING MEDICAL GROUP.
A complete listing of Members that are eligible for Capitation Services is provided in the monthly Eligibility Report, as set forth in Article VI.
To promptly provide, arrange through referral, or authorize all Capitation Services, and to authorize or arrange for the provision of all Non-Capitated Services, and further, to accept full financial responsibility for all Capitation Services provided, authorized or arranged through referral, by PARTICIPATING MEDICAL GROUP in accordance with the provisions of this Agreement.
The numbers and types (in terms of training, experience, and specialization) of Network Providers required to furnish Capitation Services and other Covered Services in a timely manner.
All co-payments applicable to Capitation Services rendered to Members shall be subtracted from Capitation Services expenses.
The Contractor shall prior authorize all other Capitation Services, in accordance with the practice guidelines for authorization decisions developed as specified in Section 2.1.Z and the procedures in this Section.
The Contractor must maintain a Network sufficient to provide prompt access to Capitation Services and Covered Services that are not required to be delivered directly by the Contractor, including LTSS that are not provided in the Provider’s office.

More Definitions of Capitation Services

Capitation Services means all BLUE CROSS SENIOR SECURE Covered Medical Services which are not otherwise defined in this Agreement or in the Division of Financial Responsibilities (Exhibit A(1) hereto) as Non-Capitated Services, or MEDICARE BLUE USA Away From Home Care Services.

Capitation Services means all CALIFORNIAKIDS Covered Medical Services which are not otherwise defined or otherwise designated as the responsibility of BLUE CROSS in the Division of Medical Responsibilities (Exhibit A hereto).

Capitation Services means all CALIFORNIACARE Covered Medical Services which are not otherwise defined in this Agreement [ILLEGIBLE] the Division of Financial Responsibilities (Exhibit A-1 hereto) as Non-Capitated Services.