MCO Service Area definition

MCO Service Area all the counties included in any BMS’ defined service area within which the MCO has been contracted to provide MCO services. Medicaid – the West Virginia Medical Assistance Program operated and funded by BMS pursuant to Title XIX, Social Security Act (42 U.S.C. §1396 et seq.), and related State and Federal rules and regulations (same as Medical Assistance).
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MCO Service Area all the counties included in any BMS defined service area. All contracted MCOs operate statewide. Medicaid – the West Virginia Medical Assistance Program operated and funded by BMS pursuant to Title XIX, Social Security Act (42 U.S.C. §1396 et seq.), and related State and Federal rules and regulations (same as Medical Assistance). Medical Loss Ratio (MLR) – the ratio of the numerator (as defined in accordance with 42 CFR §438.8(e)) to the denominator (as defined in accordance with 42 CFR §438.8(f)) and subject to any applicable adjustments, as provided under this Contract and Appendix G. Medically Necessary – refers to items or services furnished or to be furnished to a patient for diagnosing, evaluating, treating, or preventing an injury, illness, condition, or disease, based on evidence-based clinical standards of care. Medically Necessary services are accepted health care services and supplies that are reasonable and necessary for the diagnosis or treatment of illness or injury; to improve the functioning of a malformed body member; to attain, maintain, or regain functional capacity; for the prevention of illness; or to achieve age-appropriate growth and development. Determination of medical necessity is based on specific criteria. Mountain Health Trust (MHT) – the name of West Virginia’s Medicaid and WVCHIP mandatory managed care program for Temporary Assistance to Needy Families (TANF), TANF- related children and adults, and WVCHIP beneficiaries who are eligible to participate in managed care. National Committee for Quality Assurance (NCQA) – the independent organization that accredits MCOs, managed behavioral health organizations, and accredits and certifies Disease Management programs. Network – doctors, hospitals, facilities, and other licensed health care professionals who contract with an MCO to give care to its enrollees.
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Examples of MCO Service Area in a sentence

  • Persons in Excluded Time status will be eligible to enroll in the product as long as they continue to reside in the MCO Service Area and meet eligibility criteria.

Related to MCO Service Area

  • Service Area means the geographic area approved by the commissioner within which an issuer is authorized to offer a Medicare Select policy.

  • Primary service area means that area within a five (5) mile radius from any imaging center owned, operated or managed by Administrator, Parent or their Affiliates for which the Group provides professional Radiology services or any hospital at which on-site professional Radiology services are then provided by Physician Employee(s) or Physician Extender Employee(s) of the Group.

  • Service Areas means those areas within the Building used for stairs, elevator shafts, flues, vents, stacks, pipe shafts and other vertical penetrations (but shall not include any such areas for the exclusive use of a particular tenant).

  • Geographic Service Area or “Service Area” means an area as defined in Section 1345(k) of the Health and Safety Code.

  • Established geographic service area means a geographic area, as approved by the Commissioner and based on the carrier's certificate of authority to transact insurance in this state, within which the carrier is authorized to provide coverage;

  • Licensed service area means the geographic area in which the home service provider is authorized by law or contract to provide commercial mobile radio service to the customer.

  • Municipal Service Area means the geographical area within the legal boundaries of the Municipality where the Company has been granted rights hereunder in connection with, among other matters, Natural Gas Distribution Service, as altered from time to time;

  • Health service area or “HSA” refers to the distinct geographic regions described in Section 4.1.4 or the Vermont Blueprint for Health Manual.

  • Planning and service area or “PSA” means a geographic area of the state that is designated by the commission for purposes of planning, development, delivery and overall administration of services under a multiyear area plan. “PSA” may be interpreted as either singular or plural dependent on context. “Provider” means any person, company, firm, association or other legal entity that provides services

  • Video service provider or "provider" means a person authorized under this act to provide video service.

  • New Service Customers means all customers that submit an Interconnection Request, a Completed Application, or an Upgrade Request that is pending in the New Services Queue. New Service Request:

  • Video service means video programming, cable services, IPTV, or OVS provided through facilities located at least in part in the public rights-of-way without regard to delivery technology, including internet protocol technology. This definition does not include any video programming provided by a commercial mobile service provider defined in 47 USC 332(d) or provided solely as part of, and via, a service that enables users to access content, information, electronic mail, or other services offered over the public internet.

  • Person-Centered Service Plan means the details of the supports, desired outcomes, activities, and resources required for an individual to achieve and maintain personal goals, health, and safety, as described in OAR 411-004-0030.

  • Covered Services means all or a part of those medical and health services set forth in rule 441—86.14(514I).

  • Basic generation service provider or "provider" means a

  • Wireless service provider means a person that provides wireless service to the public.

  • Service Switching Point (SSP means the telephone Central Office Switch equipped with a Signaling System 7 (SS7) interface.

  • Covered Building Service Employee means any person performing building service work for a Covered Building Service Employer, either directly or through a contract or subcontract.

  • Planned Service Interruption means a Service Interruption that has been scheduled to occur in accordance with schedule 5;

  • energy service provider means a natural or legal person who delivers energy services or other energy efficiency improvement measures in a final customer’s facility or premises;

  • Cemetery services means cremations, grave openings and closings, and installation of grave memorials.

  • Data Center(s) means the site or sites at which the Software will be hosted to provide the Authorized Services to Customers. Such site or sites shall at all times be owned or controlled by the Provider.

  • Service Switching Point (SSP) is a telephone central office switch equipped with a Signaling System 7 (SS7) interface.

  • Service Location means a location at which a member obtains a covered service provided by a physician or other licensed practitioner of the healing arts under the terms of a contract.

  • Service Locations means those locations set forth on Exhibit B.

  • BPO Services means Provider’s business process outsourcing services described in the applicable Solution Exhibit, whereby Provider assumes responsibility for Customers’ business processes.