Managed Care Technical Manual definition

Managed Care Technical Manual or “MCTM” A document developed by the Department that provides the technical specifications for the submission of encounters and other contract deliverables, including monthly, quarterly, annual, and other required reports from MCOs. In addition, it supplies technical information on enrollment and payment files, Department- generated files, and Departmental processes such as the processing of incarcerated members and the reconciliation of payments for newborn members.

Examples of Managed Care Technical Manual in a sentence

  • The Managed Care Technical Manual details the required reporting data elements.

  • This Contract includes the program requirements and specifications as outlined in RFP 2017-03, this Contract, and the Managed Care Technical Manual.

  • The Contractor agrees to adhere to all additional reporting requirements related to the xxxxxx care and adoption assistance population, as outlined in the Managed Care Technical Manual.

  • The Contractor agrees to adhere to all additional reporting requirements related to the xxxxxx care population, as outlined in the Managed Care Technical Manual.

  • Subcontracts which require the subcontractor to be responsible for the provision of covered services must include the terms set forth in the Managed Care Technical Manual and for the purposes of this Contract, that the subcontractor shall be considered both a subcontractor and network provider.

  • The Contractor shall submit its policies and procedures in accordance with the Managed Care Technical Manual.

  • The total number of calls received pertaining to patients in EDs needing assistance in accessing care in an alternative setting shall be tracked and reported as outlined in the Medallion 4.0 Managed Care Technical Manual.

  • The Contractor must submit to the department an annual report detailing all efforts to engage key partners and establish community based partnerships, in accordance with the Managed Care Technical Manual.

  • Subcontracts which require the subcontractor to be responsible for the provision of covered services must include the terms set forth in the Managed Care Technical Manual, and for the purposes of this Contract, that the subcontractor shall be considered both a subcontractor and network provider Contractor shall adhere to subcontractor specific restrictions found herein Sections 13 and 14.

  • The Contractor shall be entitled to a capitation payment for the member based on the recoupment/reconciliation procedures in Section 12 and the Managed Care Technical Manual.

Related to Managed Care Technical Manual

  • Project Manual means the volume usually assembled for the Work which may include the bidding requirements, sample forms, and other Contract Documents.

  • 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.

  • Technical data means recorded information, regardless of the form or method of the recording, of a scientific or technical nature (including computer software documentation). The term does not include computer software or data incidental to contract administration, such as financial and/or management information.

  • User Manual means the user guide, Help guide, and other documentation provided with the software, updated agreements provided on the website of Quick Heal (xxx.xxxxxxxxx.xxx), explanatory or other materials as provided from time to time by Quick Heal.

  • technical specification means a document that prescribes technical requirements to be fulfilled by a product, process or service;

  • Technical Specifications A specification in a document defining the characteristics of a product or a service, such as the quality levels, the environmental and climate performance levels, the design for all needs, including accessibility for people with disabilities, and the evaluation of conformity, of product performance, of the use of the product, safety or dimensions, as well as requirements applicable to the product as regards the name by which it is sold, terminology, symbols, testing and test methods, packaging, marking or labelling, instructions for use, the production processes and methods at every stage in the life cycle of the supply or service, as well as the evaluation and conformity procedures;

  • Technical safeguards means the technology and the policy and procedures for its use that 27 protect electronic PHI and control access to it.

  • Managed Care Program means the process that determines Medical Necessity and directs care to the most appropriate setting to provide quality care in a cost-effective manner, including Prior Authorization of certain services.

  • MSAA Indicator Technical Specifications document means, as the context requires, either or both of the document entitled “Multi-Sector Service Accountability Agreement (MSAA) 2019-20 Indicator Technical Specifications November 5, 2018 Version 1.3” and the document entitled “Multi-Sector Service Accountability Agreement (MSAA) 2019-20 Target and Corridor-Setting Guidelines” as they may be amended or replaced from time to time;

  • Web Site Accessibility Standards/Specifications means standards contained in Title 1 Texas Administrative Code Chapter 206.

  • Pharmacy technician or “technician” means a person who is employed in Iowa by a licensed pharmacy under the responsibility of an Iowa-licensed pharmacist to assist in the technical functions of the practice of pharmacy, and who is registered pursuant to 657—Chapter 3, and includes a certified pharmacy technician, a pharmacy technician trainee, and an uncertified pharmacy technician.

  • Provider Manual means a working document, including but not limited to BCBSM published bulletins and provider notices, that provide specific guidelines and direction by which providers may meet their contractual responsibility as described in this Agreement. Provider Manuals are published on web-DENIS.

  • Managed Care Plans means all health maintenance organizations, preferred provider organizations, individual practice associations, competitive medical plans and similar arrangements.

  • Clinical nurse specialist means a registered nurse with relevant post-basic qualifications and 12 months’ experience working in the clinical area of his/her specified post-basic qualification, or a minimum of four years’ post-basic registration experience, including three years’ experience in the relevant specialist field and who satisfies the local criteria.

  • Certified pharmacy technician or “certified technician” means an individual who holds a valid current national certification and who has registered with the board as a certified pharmacy technician.

  • Design Manual means the MOHLTC design manual or manuals in effect and applicable to the development, upgrade, retrofit, renovation or redevelopment of the Home or Beds subject to this Agreement.

  • Project Implementation Manual or “PIM” means the manual setting out the measures required for the implementation of the Project, as the same may be amended from time to time, subject to prior approval of the Association;

  • Technical Standards means the technical standards set out in paragraph 2.4 of the Order Form;

  • Electronic Subcontracting Reporting System (eSRS) means the Governmentwide, electronic, web-based system for small business subcontracting program reporting. The eSRS is located at http://www.esrs.gov.

  • Contractor Software means software which is proprietary to the Contractor, including software which is or will be used by the Contractor for the purposes of providing the Services.

  • Program Materials means the documents and information provided by the Program Administrator specifying the qualifying EEMs, technology requirements, costs and other Program requirements, which include, without limitation, program guidelines and requirements, application forms and approval letters.

  • Web Site Accessibility Standards/Specifications means standards contained in Title 1 Texas Administrative Code Chapter 206.

  • Brand Name Specification means a specification limited to one or more items by manufacturers’ names or catalogue number.

  • Clinical Data means the information concerning the safety or performance that is generated from the use of a device and that are sourced from the following:

  • Licensed clinical social worker means an individual who meets the licensed clinical social worker requirements established in KRS 335.100.