Encounter definition

Encounter means a record of a medically-related service rendered by an AHCCCS-registered provider to a member enrolled with a contractor on the date of service.

Encounter means a Covered Service or group of Covered Services delivered by a Provider to a Member during a visit between the Member and Provider. This also includes Value-added Services. Encounter Data means data elements from Fee-for-Service claims or capitated services proxy claims that are submitted to HHSC by the HMO in accordance with HHSC’s required format for Medicaid and CHIP HMOs.

Encounter means an individual service or procedure provided to an Enrollee that would result in a claim if the service or procedure were to be reimbursed as FFS under the HFS Medical Program.

Examples of Encounter in a sentence

• Internal Control Number — The unique number assigned by the Department’s MMIS to identify an individual Claim or Encounter.

• A single monthly case rate payment will be paid to the Contractor only for months with qualifying encounters that meet the criteria as outlined in the Encounter Data Reporting Guide.

• A single monthly case rate or encounter payment up to the specified maximum will be paid to the Contractor only for months with qualifying encounters that meet the criteria as outlined in the Encounter Data Reporting Guide.

• Encounter Data for all services must be submitted within the time frames established by United pursuant to the State Contracts, regardless of whether reimbursement for such services is made by United either directly or indirectly through capitation.

• Enrollee Encounter Data — The information relating to the receipt of any item(s) or service(s) by an Enrollee under a contract between the State and a PH-MCO that is subject to the requirements of 42 C.F.R. §438.242 and 42 C.F.R. §438.818.

More Definitions of Encounter

Encounter means an instance of an individual presenting at the emergency center who satisfies the criteria in section R386-702-3(2); and

Encounter means a Covered Service or group of Covered Services delivered by a Provider to a Member during a visit between the Member and Provider. This also includes Value-added Services. Encounter Data means data elements from Fee-for-Service claims or capitated services proxy claims that are submitted to HHSC by the MCO in accordance with HHSC’s required format for Medicaid and CHIP MCOs. Enrollment Report/Enrollment File means the daily or monthly list of Eligibles that are enrolled with an MCO as Members on the day or for the month the report is issued. EPSDT means the federally mandated Early and Periodic Screening, Diagnosis and Treatment program contained at 42 U.S.C. 1396d(r). The name has been changed to Texas Health Steps in the State of Texas. Exclusive Provider Organization (EPO) means an insurer with an Exclusive Provider Benefit Plan approved by TDI in accordance with 28 T.A.C. §3.9201-3.9212

Encounter means the record of a service submitted to or by the Division and processed by AHCCCS that is rendered by a provider registered with AHCCCS to a member who is enrolled with the Division on the date of service for which the Division incurs a financial liability (A.A.C. R9-22-107.13).

Encounter means a face-to-face visit, which may include a visit using telemedicine, between a patient and a primary care provider during which primary care services are provided.

Encounter means a face to face contact between a health care professional and a CDIB cardan IHS eligible SoonerCare member for the provision of medically necessary Title XIX or Title XXI covered services through an IHS or Tribal 638 facility or an urban Indian clinic within a 24-hour period ending at midnight, as documented in the patient's record.

Encounter means a record of a covered service rendered by a provider to a person enrolled with a capitated RBHA on the date of service.

Encounter means a single health care service or a period of examination or treatment.