Managed Care Contract definition

Managed Care Contract shall --------------------- include any Capitation/Case Rate Revenues contract, or any contracts based on a fee-for-service payment methodology or discounted fee-for-service reimbursement methodology and other agreements with third party payors, alternative delivery systems or other purchasers of group health care services.
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Managed Care Contract means the agreement between the agency and an MCO to provide prepaid contracted services to enrollees.
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Managed Care Contract means the agreement between the agency and an MCO to provide prepaid con- tracted services to enrollees.
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Examples of Managed Care Contract in a sentence

  • Please see the Uniform Managed Care Contract Terms & Conditions and Attachment B-5, Deliverables/Liquidated Damages Matrix.

  • The Contract between the Parties will consist of the HHSC Managed Care Contract document and all attachments and amendments.

  • In addition, legal notices must be sent to the Legal Contact identified in the HHSC Managed Care Contract document.

  • Refer to Attachment A, "Uniform Managed Care Contract Terms and Conditions," Section 4.08(c) for information regarding Readiness Reviews of the MCO’s Material Subcontractors.

  • See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program.

  • Refer to the HHSC Uniform Managed Care Contract Terms and Conditions (Attachment A) and the Liquidated Damages Matrix (Attachment B-5) for additional information.

  • Compensation for medical expenses shall be paid if an insured event occurs during the period of validity of the insurance contract and an insured person has suffered justified medical expenses due to such event that will not be covered by the national health insurance system of the Republic of Estonia (Estonian Health Insurance Fund).

  • No later than the Effective Date of the Contract, the HMO must designate and identify Key HMO Personnel that meet the requirements in HHSC Uniform Managed Care Contract Terms & Conditions, Article 4.

  • If the Contractor is or will be subject to the health insurer’s premium fee for the Capitation Payments being made under this or a previously existing Managed Care Contract with the Commonwealth, the Commonwealth shall compensate the Contractor for that fee and for any federal taxes resulting from such compensation.

  • For further information, HMOs should refer to the HHSC Uniform Managed Care Contract Terms and Conditions.


More Definitions of Managed Care Contract

Managed Care Contract means an agreement with a managed care organization or other Third Party providing for a Discount other than an agreement with respect to a Government Health Care Program.
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Managed Care Contract means a contract or agreement for Hospital Services between ENH and a Payor, including but not limited to rates, definitions, terms, conditions, policies, and pricing methodology (e.g., per diem, discount rate, and case rate).
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Managed Care Contract means any agreement, contract or commitment of or with (directly or indirectly through an independent practice association or other health care provider network) a third party payor, including a federal or state government program (e.g. Medicare or Medicaid), insurance company, self-insured employer, healthcare service plan, non-profit hospital insurance plan or health maintenance organization, for the provision of health care services to any person or persons or for reimbursement of health care services rendered to such person or persons.
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Managed Care Contract means the agreement between the agency and an MCO or PAHP to provide prepaid contracted services to enroll- ees.
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Related to Managed Care Contract

  • Managed care plan means a health benefit plan that either requires a covered person to use, or

  • Managed care means a system that provides the coordinated delivery of services and supports that are necessary and appropriate, delivered in the least restrictive settings and in the least intrusive manner. Managed care seeks to balance three factors: achieving high-quality outcomes for participants, coordinating access, and containing costs.

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • HMO a health maintenance organization doing business as such (or required to qualify or to be licensed as such) under HMO Regulations.

  • Medicare cost report means CMS-2552-10, the cost report for electronic filing of

  • Continuing care contract means, as stated in RCW 70.38.025, a contract providing a person, for the duration of that person's life or for a term in excess of one year, shelter along with nursing, medical, health-related, or personal care services, which is conditioned upon the transfer of property, the payment of an entrance fee to the provider of such ser- vices, or the payment of periodic charges for the care and ser- vices involved. A continuing care contract is not excluded from this definition because the contract is mutually termina- ble or because shelter and services are not provided at the same location.

  • Medicaid program means the Kansas program of medical

  • Medicaid means that government-sponsored entitlement program under Title XIX, P.L. 89-97 of the Social Security Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set forth on Section 1396, et seq. of Title 42 of the United States Code.

  • Adult foster care facility means an adult foster care facility licensed under the adult foster care facility licensing act, 1979 PA 218, MCL 400.701 to 400.737.

  • Child care facility or “facility” means a child care center, a preschool, or a registered child development home.

  • Database Management System (DBMS) A system of manual procedures and computer programs used to create, store and update the data required to provide Selective Routing and/or Automatic Location Identification for 911 systems. Day: A calendar day unless otherwise specified. Dedicated Transport: UNE transmission path between one of CenturyLink’s Wire Centers or switches and another of CenturyLink’s Wire Centers or switches within the same LATA and State that are dedicated to a particular customer or carrier. Default: A Party’s violation of any material term or condition of the Agreement, or refusal or failure in any material respect to properly perform its obligations under this Agreement, including the failure to make any undisputed payment when due. A Party shall also be deemed in Default upon such Party’s insolvency or the initiation of bankruptcy or receivership proceedings by or against the Party or the failure to obtain or maintain any certification(s) or authorization(s) from the Commission which are necessary or appropriate for a Party to exchange traffic or order any service, facility or arrangement under this Agreement, or notice from the Party that it has ceased doing business in this State or receipt of publicly available information that signifies the Party is no longer doing business in this State.

  • Health care facility or "facility" means hospices licensed

  • Provider contract means any contract between a provider and a carrier (or a carrier's network,

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

  • MCO means an organization having a certificate of authority or certificate of registration from the 11 Washington State Office of Insurance Commissioner that contracts with HCA under a comprehensive 12 risk contract to provide prepaid health care services to eligible HCA Enrollees under HCA managed 13 care programs.

  • PCI DSS means the Payment Card Industry Data Security Standard, issued by the Payment Card Industry Security Standards Council, as may be revised from time to time.