Medicaid reimbursement definition

Medicaid reimbursement means any amount to be paid by the Medicaid beneficiary as a Medicaid copayment or spenddown and any amount to be paid by the department after application of any applicable Medicaid copayment or spenddown.

Medicaid reimbursement means the payment made to Medicaid providers for Medicaid services rendered to eligible recipients.

Examples of Medicaid reimbursement in a sentence

• The NCCI includes the creation and implementation of claims processing edits to ensure correct coding on claims submitted for Medicaid reimbursement.

• Notify SPD in writing within 30 days of the certification survey that it elects to gradually withdraw from the Medicaid Program; (B) Request Medicaid reimbursement for any resident who resided in the facility, or who was eligible for right of return under OAR 411-088-0050 or right of readmission under OAR 411-088-0060, on the date of the notice required by this rule.

• During the Texas Medicaid enrollment process, with HHSC approval, the Claims Adminis- trator may waive the mandatory prerequisite for Medicare enrollment for certain providers whose type of practice will never serve Medicare-eligible individuals (e.g., pediatrics, obstetrician/gynecologist [OB/ GYN]).Providers must maintain a valid, current license or certification to be entitled to Texas Medicaid reimbursement.

• The Contractor shall allow the State access to any data upon its request to records related to 340B purchased drugs, exclusion from Medicaid reimbursement, and utilization reports.

• The Contractor must maintain records that are clear and auditable that include billing instructions and methods by which 340B claims are excluded from Medicaid reimbursement.

• Federal law, regulation, or policy change: If the federal government changes policy affecting Medicaid reimbursement, the State must adjust P1 and P2 to reflect all changes.

• Any reduced, discounted, free, or special fee advertised to the public must also be offered to Texas Medicaid clients.• Services were provided without regard to race, color, sex, national origin, age, or handicap.• The provider of health care and services files a claim with Texas Medicaid agreeing to accept the Medicaid reimbursement as payment in full for those services covered under Texas Medicaid.

• Federal law, regulation, or policy change: If the federal government changes policy affecting Medicaid reimbursement, the State must adjust P1 and P2 to reflect all changes.• Once the State’s FFS institutional excess UPL is phased out, CMS will no longer match excess institutional UPL payments.♦ Excess payments addressed through transition periods should not be included in the 1915(b) cost-effectiveness process.

• The effective date of CHOICES enrollment and Medicaid reimbursement of NF services shall not be earlier than the MOPD.

• Physician certification is not needed if there is no third party payor source (Medicaid/FAMIS, TRICARE or private health insurance), nor is it needed in order to receive Medicaid reimbursement for assessments.