Case rate means the maximum premium rate or schedule of premium rates permitted to be charged with respect to the cov- erage of a creditor. Unless a higher premium rate or schedule of premium rates is approved by the commissioner, the case rate is the prima facie premium rate or schedule of premium rates.
Case rate means a method of payment based on diagnosis. Case
Case rate means a method of payment based on diagnosis. Case rate assumes that a given set of services shall be provided and the rate is based on the total compensation for those services.
Examples of Case rate in a sentence
The offeror shall submit the following information: The Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate; and Total Case Rate (TCR) for the specified five (5) Calendar Years (CY), as well as a safety narrative, as described further below.
More Definitions of Case rate
Case rate means a flat fee paid for newborn nurse home visiting services. The case rate includes all newborn nurse home visiting services, including Community Lead Service Requirements outlined in OAR 333-006-0050 and Newborn Nurse Home Visiting Provider and Service Requirements outlined in OAR 333-006-0100 through333-006-0130. The case rate is also known as a bundled claim.¶
Case rate means the all inclusive Anthem Rate for an entire admission or one outpatient encounter. "Global Case Rate" means the all inclusive Anthem Rate which includes facility, professional and physician services for specific Coded Service Identifier(s).
Case rate means the sum of all allowed charges for Medically Necessary Services provided during or in relation to an Episode of Care (inclusive of all technical, professional, facility, and other medical services) billed by Providers. Covered Services included in a Case Rate commonly include, but are not limited to: (a) the Medically Necessary Services rendered by a Provider during an Episode of Care (b) equipment used by a hospital or facility; (c) in-hospital or in-facility medications or biologics and supplies; (d) implants; (e) laboratory testing and services; (f) in-hospital meals; (g) hospital confinement days; (h) in-hospital or in-facility nursing care; (i) in-hospital physical therapy; and (j) post-discharge follow-up consultations occurring within the applicable global period defined by the Centers for Medicare & Medicaid Services (“CMS”). Services commonly excluded from a Case Rate include, but are not limited to: (1) medical consultations and certain diagnostic testing provided in advance of a medical procedure to determine whether or not such procedure is a Medically Necessary Service; (2) Convenience Items; (3) Travel Services; and (4) any medical procedure or medical care that is not a Medically Necessary Service.
Case rate. On a monthly basis, gross case rate payments are calculated based on the Contractor's assigned capacity, by population, multiplied by the contracted case rate (gross Final Jun 6-01 Effective 7-01-01 Page 94 -------------------------------------------------------------------------------- [LOGO] Community Partnership FEE FOR SERVICE and RISK-BASED of Southern Arizona SUBCONTRACT AGREEMENT Regional Behavioral CHILDREN SERVICES Health Authority The Providence Service Corporation ------------------------------------------------- CONTRACT NUMBER: A0108 FY 01/02 -------------------------------------------------------------------------------- case rate). The gross case rate is reduced by the monthly pharmacy withhold amount resulting in the net case rate payment. The case rate includes Medicare co-insurance and deductibles where applicable. Assuming actual enrolled members do not fall below 85% of capacity for SMI members and 90% of capacity for Children, the total funded amount will remain constant. In the event actual assigned members fall below the thresholds described above, RBHA retains the right to review for consideration of appropriate adjustment of Contractor's capacities and/or case rates. In the event assigned/enrolled SMI members or Children exceed 110% of system wide capacity, the RBHA and the Contractor shall review and may consider adjustments as appropriate. The RBHA also may adjust capacity downward if enrollment decreases are due to member dissatisfaction or other quality or programmatic issues, resulting in increased assignments to other contracted Contractors.
Case rate. On a monthly basis, gross case rate payments are calculated based on the Contractor's assigned capacity, by population, multiplied by the contracted case rate (gross case rate). The gross case rate is reduced by the monthly pharmacy withhold amount resulting in the net case rate payment. The case rate includes Medicare co-insurance and deductibles where applicable. Assuming actual enrolled members do not fall below 85% of capacity for SMI members and 90% of capacity for Children, the total funded amount will remain constant. In the event actual assigned members fall below the thresholds described above, RBHA retains the right to review for consideration of appropriate adjustment of Contractor's capacities and/or case rates. In the event assigned/enrolled SMI members or Children exceed 110% of system wide capacity, the RBHA and the Contractor shall review and may consider adjustments as appropriate. The RBHA also may adjust capacity downward if enrollment decreases are due to member dissatisfaction or other quality or programmatic issues, resulting in increased assignments to other contracted Contractors.
Case rate means a flat rate paid per Member for a specific range of services. A Case Rate may be paid for each referral made to a Provider or for each admission made to a hospital. The Provider receiving the payment assumes the risk of providing all Covered Services for the full range of services for each Member for whom the payment was made.
Case rate means a flat rate paid per OHP Member for a specific range of services. A Case Rate may be paid for each referral made to a Provider or for each admission made to a hospital. The Provider receiving the payment assumes the risk of providing all Covered Services for the full range of services for each OHP Member for whom the payment was made.