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: 1) Product name; 2) Units;
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Examples of Medicaid Utilization in a sentence

  • Providers who meet the minimum Medicaid utilization and staffing criteria may receive the High Medicaid Utilization and High Direct Patient Care add-on.

  • The Manufacturer shall have the right to disclose Medicaid Utilization Information to auditors who agree to keep such information confidential.

  • Medicaid Utilization and Net Cost Data - PIHPs are required to submit Medicaid Utilization and Net Cost Reports annually.

  • Interest on the Rebates payable this Agreement begins accruing 38 calendar days from receipt of Iowa’s Medicaid Utilization Information sent to the Manufacturer, and interest will continue to accrue until the postmark date of the Manufacturer’s payment.

  • The Manufacturer will hold the Medicaid Utilization Information confidential.

  • The Role of Increased Cost Sharing on Medicaid Utilization Under the Deficit Reduction Act.

  • Interest on the Rebates payable under this Agreement begins accruing 90 calendar days from the Manufacturer’s receipt of Maine’s Medicaid Utilization Information, and interest will continue to accrue until the postmark date of the Manufacturer’s payment.

  • Therefore, beginning with the FY’11 Medicaid Utilization and Net Cost Report, PIHPs must report these EPSDT services as unique units and costs in a separate column.

  • The Medicaid Utilization Management Program (MUMP) determines covered lengths of stay in inpatient, general and rehabilitative hospitals, both in state and out of state.

  • PIHPs will continue reporting the cases, units and costs of each procedure code on the annual Medicaid Utilization and Net Cost Report (MUNC).


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.
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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 program means the Kansas program of medical

  • 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 means public usage of the subway, bus, railroad

  • Availability Standards has the meaning set forth in the CAISO Tariff.

  • Medicaid Regulations means, collectively, (i) all federal statutes (whether set forth in Title XIX of the Social Security Act or elsewhere) affecting the medical assistance program established by Title XIX of the Social Security Act and any statutes succeeding thereto; (ii) all applicable provisions of all federal rules, regulations, manuals and orders of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in clause (i) above and all federal administrative, reimbursement and other guidelines of all Governmental Authorities having the force of law promulgated pursuant to or in connection with the statutes described in clause (i) above; (iii) all state statutes and plans for medical assistance enacted in connection with the statutes and provisions described in clauses (i) and (ii) above; and (iv) all applicable provisions of all rules, regulations, manuals and orders of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in clause (iii) above and all state administrative, reimbursement and other guidelines of all Governmental Authorities having the force of law promulgated pursuant to or in connection with the statutes described in clause (ii) above, in each case as may be amended, supplemented or otherwise modified from time to time.

  • Fertilization means the fusion of a human spermatozoon with a human ovum.

  • Utilization review organization means an entity that conducts utilization review, other than a health carrier performing a review for its own health plans.

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

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

  • NERC Reliability Standards means the most recent version of those reliability standards applicable to the Generating Facility, or to the Generator Owner or the Generator Operator with respect to the Generating Facility, that are adopted by the NERC and approved by the applicable regulatory authorities, which are available at xxxx://xxx.xxxx.xxx/files/Reliability_Standards_Complete_Set.pdf, or any successor thereto.

  • Baseline Personnel Security Standard means the pre-employment controls for all civil servants, members of the Armed Forces, temporary staff and government contractors generally.

  • Accessibility Standards means accessibility standards and specifications for Texas agency and institution of higher education websites and EIR set forth in 1 TAC Chapter 206 and/or Chapter 213.

  • 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 cybersecurity protection, and the design of planned additions or modifications to such facilities to the extent necessary for reliable operation of the bulk power system, but shall not include any requirement to enlarge bulk power system facilities or to construct new transmission capacity or generation capacity.

  • Service Availability The total number of minutes in a calendar quarter that the Tyler Software is capable of receiving, processing, and responding to requests, excluding maintenance windows, Client Error Incidents and Force Majeure.

  • Reliability Standards means the criteria, standards, rules and requirements relating to reliability established by a Standards Authority.

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

  • Medically necessary care means care that is (1) appropriate and consistent with and essential for the prevention, diagnosis, or treatment of a Patient’s condition; (2) the most appropriate supply or level of service for the Patient’s condition that can be provided safely; (3) not provided primarily

  • Utilization plan means a form and additional documentation included in all bids or proposals that demonstrates a vendor’s proposed utilization of vendors certified by the Business Enterprise Program to meet the targeted goal. The Utilization Plan shall demonstrate that the Vendor has either: (1) met the entire contract goal or (2) requested a full or partial waiver and made Good Faith Efforts towards meeting the goal.

  • Applicable water quality standards means all water quality standards to which a discharge is subject under the federal Clean Water Act and which has been (a) approved or permitted to remain in effect by the Administrator following submission to the Administrator pursuant to Section 303(a) of the Act, or (b) promulgated by the Director pursuant to Section 303(b) or 303(c) of the Act, and standards promulgated under (APCEC) Regulation No. 2, as amended.

  • Medicaid Provider Agreement means an agreement entered into between a state agency or other such entity administering the Medicaid program and a health care provider or supplier under which the health care provider or supplier agrees to provide services for Medicaid patients in accordance with the terms of the agreement and Medicaid Regulations.

  • 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.

  • CAISO Grid means the system of transmission lines and associated facilities of the Participating Transmission Owners that have been placed under the CAISO’s operational control.

  • 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.

  • Medicaid Certification means a certification by a state agency or other entity responsible for certifying Medicaid providers and suppliers that a health care provider or supplier is in compliance with all the conditions of participation set forth in the Medicaid Regulations.

  • Health care facilities means buildings, structures, or equipment suitable and intended for, or incidental or ancillary to, use in providing health services, including, but not limited to, hospitals; hospital long-term care units; infirmaries; sanatoria; nursing homes; medical care facilities; outpatient clinics; ambulatory care facilities; surgical and diagnostic facilities; hospices; clinical laboratories; shared service facilities; laundries; meeting rooms; classrooms and other educational facilities; students', nurses', interns', or physicians' residences; administration buildings; facilities for use as or by health maintenance organizations; facilities for ambulance operations, advanced mobile emergency care services, and limited advanced mobile emergency care services; research facilities; facilities for the care of dependent children; maintenance, storage, and utility facilities; parking lots and structures; garages; office facilities not less than 80% of the net leasable space of which is intended for lease to or other use by direct providers of health care; facilities for the temporary lodging of outpatients or families of patients; residential facilities for use by the aged or disabled; and all necessary, useful, or related equipment, furnishings, and appurtenances and all lands necessary or convenient as sites for the health care facilities described in this subdivision.

  • HCPCS means the Healthcare Common Procedure Coding System.