CHOICES Member definition

CHOICES Member. A member who has been enrolled by TENNCARE into CHOICES. Chronic Condition – as defined by Population Health (and AHRQ) is a condition that lasts twelve (12) months or longer and meets one of both of the following tests: (a) it places limitation on self-care, independent living, and social interactions; (b) it results in the need for ongoing intervention with medical products, services, and special equipment (see Xxxxxx et al., 1993). Clean Claim – A claim received by the CONTRACTOR for adjudication that requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by the CONTRACTOR. Clinical Practice Guidelines – Systematically developed tools or standardized specifications for care to assist practitioners and patient decisions about appropriate care for specific clinical circumstances. Such guidelines are typically developed through a formal process and are based on authoritative sources that include clinical literature and expert consensus. CMS – Centers for Medicare & Medicaid Services. Community-Based Residential Alternatives (CBRA) to institutional care – For purposes of CHOICES and ECF CHOICES:
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CHOICES Member. A member who has been enrolled by TENNCARE into CHOICES. Clean Claim – A claim received by the CONTRACTOR for adjudication that requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by the CONTRACTOR. Clinical Practice Guidelines – Systematically developed tools or standardized specifications for care to assist practitioners and patient decisions about appropriate care for specific clinical circumstances. Such guidelines are typically developed through a formal process and are based on authoritative sources that include clinical literature and expert consensus. Clinically Related Group 1: Severely and/or Persistently Mentally Ill (SPMI) – Persons in this group are 18 years or older with a valid DSM-IV-TR (and subsequent revisions) diagnosis excluding substance use disorders, developmental disorders or V-codes. They are recently severely impaired and the duration of their severe impairment totals six months or longer of the past year.
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CHOICES Member. A member who has been enrolled by TENNCARE into CHOICES. Clean Claim – A claim received by the CONTRACTOR for adjudication that requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by the CONTRACTOR.
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Examples of CHOICES Member in a sentence

  • The agreement between a CHOICES Member electing CD of HCBS who has a Representative direct and manage the Member’s Worker(s) and the Member’s Representative that specifies the roles and responsibilities of the Member and the Member’s Representative.

  • The agreement between a CHOICES Member electing CD of HCBS (or the Member’s Representative) and the Member’s Consumer-Directed Worker that specifies the roles and responsibilities of the Member (or the Member’s Representative) and the Worker.

  • The agreement between a CHOICES Member electing CD of Eligible CHOICES HCBS who has a Representative direct and manage the Member’s Worker(s) and the Member’s Representative that specifies the roles and responsibilities of the Member and the Member’s Representative.

  • The agreement between a CHOICES Member electing CD of Eligible CHOICES HCBS (or the Member’s Representative) and the Member’s Consumer-Directed Worker that specifies the roles and responsibilities of the Member (or the Member’s Representative) and the Worker.

  • The CONTRACTOR shall be responsible for immediately initiating disenrollment of any member who is not receiving TennCare-reimbursed long-term services and supports and is not expected to resume receiving long-term services and supports within the next thirty(30) days, except under extenuating circumstances which must be reported to TennCare on the CHOICES Member Experience Report.

  • When the term CHOICES Member, ECF CHOICES Member, or Katie Beckett Member is used, the provision only applies to individuals in that particular program who Consumer Direct.

  • ECF CHOICES Member - A member who has been enrolled by TENNCARE into ECF CHOICES.

  • Collection of any Patient Liability amounts due from an ECF CHOICES Member pursuant to federal post-eligibility provisions shall be the responsibility of the member’s MCO.


More Definitions of CHOICES Member

CHOICES Member. A member who has been enrolled by TENNCARE into CHOICES. Chronic Condition – as defined by Population Health (and AHRQ) is a condition that lasts 12 months or longer and meets one of both of the following tests: (a) it places limitation on self-care, independent living, and social interactions; (b) it results in the need for ongoing intervention with medical products, services, and special equipment (see Xxxxxx et al., 1993). Clean Claim – A claim received by the CONTRACTOR for adjudication that requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by the CONTRACTOR. Clinical Practice Guidelines – Systematically developed tools or standardized specifications for care to assist practitioners and patient decisions about appropriate care for specific clinical circumstances. Such guidelines are typically developed through a formal process and are based on authoritative sources that include clinical literature and expert consensus. CMS – Centers for Medicare & Medicaid Services. Complaint – A written or verbal expression of dissatisfaction from a member about an action taken by the CONTRACTOR or service provider other than an adverse action. The CONTRACTOR shall not treat anything as a complaint that falls within the definition of adverse action.
Sample 1
CHOICES Member. A member who has been enrolled by TENNCARE into CHOICES. Chronic Condition – as defined by Population Health (and AHRQ) is a condition that lasts twelve (12) months or longer and meets one of both of the following tests: (a) it places limitation on self-care, independent living, and social interactions; (b) it results in the need for ongoing intervention with medical products, services, and special equipment (see Xxxxxx et al., 1993). Clean Claim – A claim received by the CONTRACTOR for adjudication that requires no further information, adjustment, or alteration (including written information or substantiation) by the provider of the services in order to be processed and paid by the CONTRACTOR. Clinical Practice Guidelines – Systematically developed tools or standardized specifications for care to assist practitioners and patient decisions about appropriate care for specific clinical circumstances. Such guidelines are typically developed through a formal process and are based on authoritative sources that include clinical literature and expert consensus, including consultation with network providers. Cloning of Medical Notes - Documentation is considered cloned when each entry in the medical record for a beneficiary is worded exactly like or similar to the previous entries. Cloned documentation does not meet medical necessity requirements for coverage of services rendered due to the lack of specific, individual information. All documentation in the medical record must be specific to the patient and her/his situation at the time of the encounter. Cloning of documentation is considered a misrepresentation of the medical necessity requirement for coverage of services. Identification of this type of documentation will lead to denial of services for lack of medical necessity and recoupment of all overpayments made. CMS – Centers for Medicare & Medicaid Services. Community-Based Residential Alternatives (CBRA) to institutional care – For purposes of CHOICES and ECF CHOICES:
Sample 1
CHOICES Member. A member who has been enrolled by TENNCARE into CHOICES. Clean Claim – A claim received by the CONTRACTOR for adjudication that requires no further information, adjustment, or alteration by the provider of the services in order to be processed and paid by the CONTRACTOR. Clinical Practice Guidelines – Systematically developed tools or standardized specifications for care to assist practitioners and patient decisions about appropriate care for specific clinical circumstances. Such guidelines are typically developed through a formal process and are based on authoritative sources that include clinical literature and expert consensus. Clinically Related Group 1: Severely and/or Persistently Mentally Ill (SPMI) – Persons in this group are 18 years or older with a valid DSM-IV-TR (and subsequent revisions) diagnosis excluding substance use disorders, developmental disorders or V-codes. They Clinically Related Group 2: Persons with Severe Mental Illness (SMI) – Persons in this group are 18 years or older with a valid DSM-IV-TR (and subsequent revisions) diagnosis excluding substance use disorders, developmental disorders or V-codes. Persons in this group are recently severely impaired and the duration of their severe impairment totals less than six months of the past year.
Sample 1

Related to CHOICES Member

  • Participating member means a member who is required to make mandatory contributions by the applicable retirement act to his or her health reimbursement account.

  • Panel Member ’ means a member of a panel;

  • Faculty member means any person hired by the college or District to conduct classroom or teaching activities or who is otherwise considered by the college to be a member of faculty.

  • Alternate member means a person who is qualified under Iowa Code section 148.2A to substitute for a board member who is disqualified or becomes unavailable for any other reason for a contested case hearing. An alternate board member is deemed a member of the board only for the hearing panel(s) for which the alternate board member serves.

  • Lead Member shall, in the case of a joint venture, mean the member of such joint venture who shall have the authority to bind the contractor and each member of the Joint venture; and shall be deemed to be the Contractor for the purposes of this Agreement; the Lead Member shall itself undertake and perform at least 51% (fifty one per cent) of the total length of the Project Highway;

  • Service member means a member of the armed forces, a reserve branch of the armed forces, or the Michigan national guard.

  • Deferred member means a person who elected to receive deferred vested retirement

  • Founding Member means any individual who is either:

  • Household member means an adult living in the private residence out of which a program is operated, regardless of whether the adult is living there permanently or temporarily.

  • crew member means a person assigned by an operator to duty on an aircraft during a flight duty period;

  • Associate Member means a person appointed to perform specific statutory and non-statutory duties which have been delegated by the Trust Board for them to perform and these duties have been recorded in an appropriate Trust Board minute or other suitable record.

  • Plan Member means each Member any of the assets of which are subject to any Plan Governing Law.

  • Individual Member means a registered, financial Member of the Club who is at least 18 years of age.

  • Class Member Address Search means the Administrator’s investigation and search for current Class Member mailing addresses using all reasonably available sources, methods and means including, but not limited to, the National Change of Address database, skip traces, and direct contact by the Administrator with Class Members.

  • Initiating Member shall have the meaning provided in Section 15.2(a).

  • Non-Managing Member means any Member other than the Managing Member.

  • Designated member means the spouse, child, grandchild, parent, brother, or sister of a deceased individual who owned an interest in a wholesaler, who is entitled to inherit the deceased individual's ownership interest in the wholesaler under the terms of the deceased individual's will, or who has otherwise been designated in writing by the deceased individual to succeed the deceased individual in the wholesaler's business, or is entitled to inherit such ownership interest under the laws of intestate succession of this state. With respect to an incapacitated individual owning an ownership interest in a wholesaler, the term means the person appointed by a court as the conservator of such individual's property. The term also includes the appointed and qualified personal representative and the testamentary trustee of a deceased individual owning an ownership interest in a wholesaler.

  • Associate Members means the individuals or firms which have agreed to Joint Venture in connection with the Project;

  • ☐ - MULTI-MEMBER The “Capital Account” for each Member shall mean the account created and maintained for the Member in accordance with Section 704(b) of the Internal Revenue Code and Treasury Regulation Section 1.704-1(b)(2)(iv).

  • Class Member means a member of the Class.

  • Founding Members means the collective reference to American Multi-Cinema, Inc., a Missouri corporation, Cinemark Media, Inc., a Delaware corporation, and Regal CineMedia Holdings, LLC, a Delaware limited liability company.

  • Full Member means any person who is in one of the categories of membership referred to in Rule 10.3.

  • Teaching staff member means an employee who holds a position for which a certificate issued by the New Jersey State Board of Examiners is required.

  • Unit Member means any certificated employee of the district who is included in the appropriate unit as defined in Article 2 and therefore covered by the terms and provisions of this Agreement.

  • Active member means a member of the pension program or the individual account program

  • General Member means a party, and that party’s Affiliates, that has executed this Project Charter at the General Member level, unless that General Member has withdrawn or been terminated from the Project, or has changed membership level.