Medicaid enrollee definition

Medicaid enrollee means a Medicaid member who is enrolled in a PACE program.

Medicaid enrollee means an Enrollee in any of Plan’s Medicaid or SCHIP products.

Medicaid enrollee means an Enrollee who receives services under ABCHP’s Medicaid program, in accordance with the Medicaid Agreement and applicable Benefit Plan.

Examples of Medicaid enrollee in a sentence

• Cold-call marketing is defined in 42 CFR 438.104, which addresses marketing activities, as any unsolicited personal contact by the Contractor with a potential Medicaid enrollee.

• ENROLLEE shall mean a TennCare Medicaid enrollee who no longer meets technical eligibility requirements for Medicaid and will be afforded an opportunity to enroll in TennCare Standard in accordance with the provisions of these rules.

• Under a PACE program agreement, the department shall make a prospective monthly payment to the PACE organization of a capitation amount for each Medicaid enrollee.

• The MCO is expected to ensure that the Medicaid enrollee panel of any PCP in its network does not exceed two thousand (2,000) Medicaid enrollees.

• Upon exhaustion of the PACE organization’s appeal process, a Medicaid enrollee has the right to appeal to the department any adverse coverage or payment decision regarding any service, including any denial, reduction, or termination of any service, pursuant to 441—Chapter 7.88.87(2) Data collection, record maintenance, and reporting.

• LTSS services are covered only when a Medicaid enrollee has been determined eligible for LTSS by EOHHS.

• However, in the event the Medicaid enrollee who has received such a determination chooses to remain enrolled with the MCO, the MCO will be responsible for providing all patient care.

• At all times, the stretcher service must supply the needed personnel to safely lift and transport a Medicaid enrollee.

• FIT Team Providers shall also seek reimbursement for any Medicaid reimbursable service from Medicaid (or MCOs) when an eligible individual is a Medicaid enrollee.

• The contractor shall neither encourage nor require a Medicaid enrollee to reduce or terminate TPL coverage.

More Definitions of Medicaid enrollee

Medicaid enrollee means an individual eligible for and participating in Medicaid pursu- ant to 907 KAR 1:005, 907 KAR 20:010, 907 KAR 20:020, and 907 KAR 20:025.