Medicaid Utilization definition

Medicaid Utilization means the total number of Units of each dosage form and strength of the Manufacturer’s Supplemental Covered Product(s) reimbursed during a quarter under a Participating Medicaid Program. This utilization is based on claims paid by the Participating Medicaid Program during a calendar quarter and not drugs that were dispensed during a calendar quarter, except it shall not include drugs dispensed prior to January 1, 1991. Where a Participating Medicaid Program has elected to seek Supplemental Rebates for Medicaid MCO utilization as permitted under this Agreement, the term “Medicaid Utilization” shall also include the total number of Units of each dosage form and strength of the Manufacturer’s Supplemental Covered Product(s) for which the Participating Medicaid MCOs were responsible for covering during a quarter, except it shall in no event include drugs dispensed prior to the date the Participating Medicaid Program elects to include such Medicaid MCO utilization under Attachment A-2, and provides all required documentation supporting such election to Provider Synergies.
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Medicaid Utilization means the total number of Units of each dosage form and strength of the Manufacturer’s Preferred Products reimbursed through Fee-for-Service or dispensed through Participating Medicaid CCO programs during a Quarter under the Medicaid State Plan supporting the State’s invoice for State Supplemental Rebates. Fee-for- Service utilization information is based on claims paid during a Quarter. Participating Medicaid CCO utilization information is based on drugs dispensed with a date of service during a Quarter. Medicaid Utilization Information to be supplied includes, for each NDC number: 1) Product name; 2) Units; 3) Number of prescriptions; and 4) Total amount reimbursed. Medicaid Utilization excludes data from covered entities identified in 42 U.S.C. § 256b(a)(4) and 42 U.S.C. § 1396r-8(a)(5)(B) in accordance with 42 U.S.C. § 256b(a)(5)(A) and 42 U.S.C. § 1396r-8(a)(5)(C).
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Medicaid Utilization means the total number of Units of each dosage form and strength of the Manufacturer’s Preferred Products reimbursed through Fee-for-Service or dispensed through Participating Medicaid MCO programs during a Quarter under the Medicaid State Plan supporting the State’s invoice for State Supplemental Rebates. Fee-for-Service utilization information is based on claims paid during a Quarter. Participating Medicaid MCO utilization information is based on drugs dispensed with a date of service during a Quarter. Medicaid Utilization Information to be supplied includes, for each NDC number:
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Examples of Medicaid Utilization in a sentence

  • For the avoidance of doubt, as is the case with National Rebates, State Supplemental Rebates applicable to Participating Medicaid MCO utilization shall be payable to the DMMA, and shall not be paid directly to the Participating Medicaid MCOs, notwithstanding the Participating Medicaid MCO utilization will be invoiced separately from Fee-For-Service Medicaid Utilization.

  • In addition to the National Rebate, Manufacturer agrees to provide a State Supplemental Rebate to DMMA for Medicaid Utilization of Contracted Products that are designated as Preferred Products on the PDL during the Quarter.

  • Subject to 42 U.S.C. § 1396r-8(b)(3)(D), and subject to any other applicable state and federal law, performance of the Agreement may require Manufacturer to have access to and use of documents and data, including without limitation Medicaid Utilization data, which may be considered and/or identified as confidential and/or proprietary.


More Definitions of Medicaid Utilization

Medicaid Utilization shall also include the total number of Units of each dosage form and strength of the Manufacturer’s Supplemental Covered Product(s) for which the Participating Medicaid MCOs were responsible for covering during a quarter, except it shall in no event include drugs dispensed prior to the date the Participating Medicaid Program elects to include such Medicaid MCO utilization under Attachment A-2, and provides all required documentation supporting such election to Provider Synergies.
Sample 1
Medicaid Utilization means the total number of Units of each dosage form and strength of the Manufacturer’s Supplemental Covered Product(s) reimbursed during a quarter under a Participating Medicaid Program. This utilization is based on claims paid by the Participating Medicaid Program during a calendar quarter and not drugs that were dispensed during a calendar quarter, except it shall not include drugs dispensed prior to January 1, 1991. Where a Participating Medicaid Program has elected to seek Supplemental Rebates for Medicaid MCO utilization as permitted under this Agreement, the term “Medicaid Utilization” shall also include the total number of Units of each dosage form and strength of the Manufacturer’s Supplemental Covered Product(s) for which the Participating Medicaid MCOs were responsible forcovering during a quarter, except it shall in no event include drugs dispensed prior to the date the Participating Medicaid Program elects to include such Medicaid MCO utilization under Attachment A-2, and provides all required documentation supporting such election to Provider Synergies.
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Related to Medicaid Utilization

  • 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.

  • Utilization management section means “you or your authorized representative.” Your representative will also receive all notices and benefit determinations.

  • Reliability Standard means a requirement to provide for Reliable Operation of the Bulk Power System, including without limiting the foregoing, requirements for the operation of existing Bulk Power System Facilities, including cyber security protection, and including the design of planned additions or modifications to such Facilities to the extent necessary for Reliable Operation of the Bulk Power System, but the term does not include any requirement to enlarge Bulk Power System Facilities or to construct new transmission capacity or generation capacity. A Reliability Standard shall not be effective in the United States until approved by the Federal Energy Regulatory Commission and shall not be effective in other jurisdictions until made or allowed to become effective by the Applicable Governmental Authority. See Appendix 2 to the NERC Rules of Procedure, Definitions Used in the Rules of Procedure.

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

  • Utilization review means the prospective (prior to), concurrent (during) or retrospective (after) review of any service to determine whether such service was properly authorized, constitutes a medically necessary service for purposes of benefit payment, and is a covered healthcare service under this plan. WE, US, and OUR means Blue Cross & Blue Shield of Rhode Island. WE, US, or OUR will have the same meaning whether italicized or not. YOU and YOUR means the subscriber or member enrolled for coverage under this agreement. YOU and YOUR will have the same meaning whether italicized or not.