Medicaid vendor definition

Medicaid vendor means an entity that, under a contract with or otherwise on behalf of HHSC, performs one or more administrative services in relation to HHSC’s operation of a part of the State Medicaid program, such as claims processing, utilization review, client enrollment, provider enrollment, quality monitoring, or payment of claims. The independent auditor will deliver to the CONTRACTOR and to HHSC a report of the findings and recommendations within thirty (30) calendar days of the close of each audit. The report will be prepared in accordance with generally accepted auditing standards.
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Examples of Medicaid vendor in a sentence

  • Before a provider agreement may be issued, the DIA must recommend certification as an ICF/ID, and the Department must certify the facility as a Medicaid vendor.

  • Medicaid long-term care (SNF, ICF, ICFMR, mental hospital, and home health) expenditures were $16.7 billion in Fiscal Year 1984, accounting for 49 percent of total Federal and State Medicaid vendor payments (Table 2-6 and Table 2-7).

  • Void: This Agreement shall become null and void on the date the Provider Agency is no longer licensed to practice by the Illinois Department of Professional Regulation, under the licensure upon which their credential was based, and/or on the date upon which they cease to participate in the Department of Public Aid Medicaid vendor program.

  • Group Eligibles: Title XIX (Medicaid) recipients and applicants for Title XIX (Medicaid) vendor payment for Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) services, residing within the State.INCOME SCALE (125% of Poverty Level) For family units with more than eight (8) persons, add $4,250 annually for each additional member.

  • The service delivery process begins with a referral to the ATP, who is a Medicaid vendor.

  • When an NF resident is evacuated to a temporary shelter site, which is an unlicensed sheltering site, for greater than five days, the evacuating nursing facility may submit the claim for Medicaid vendor payment for up to an additional 15 days, provided that the evacuating nursing facility: 1.

  • DC EIP’s Medicaid vendor continued to demonstrate non-compliance during the fiscal year related to meeting timelines.

  • When an NF resident is evacuated to a temporary shelter site, which is a licensed nursing home, for greater than five days, the evacuating nursing facility may submit the claim for Medicaid vendor payment for an additional period, not to exceed 55 days, provided that: 1.

  • Consumers receiving MIPP payments have their Part B premium deducted from their Social Security award, but receive a separate payment from a NYS Medicaid vendor via check.

  • H.B. No. 3670 1 standards governing the Medicaid vendor drug program, may not 2 require prior authorization, including clinical and non-preferred 3 prior authorization, for a generic prescription drug included on 4 the Medicaid vendor drug program prescription drug formulary.

Related to Medicaid vendor

  • 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.

  • 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.

  • 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.

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

  • Centers for Medicare and Medicaid Services or “CMS” means the federal office under the Secretary of the United States Department of Health and Human Services, responsible for the Medicare and Medicaid programs.

  • Contractor / Vendor means the Tenderer whose bid has been accepted and awarded Letter of Acceptance for a specific item followed by the signing of Contract.

  • 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.

  • Medicare means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.

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

  • TRICARE means, collectively, a program of medical benefits covering former and active members of the uniformed services and certain of their dependents, financed and administered by the United States Departments of Defense, Health and Human Services and Transportation, and all laws applicable to such programs.

  • Residential child care facility means a twenty-four-hour residential facility where children live together with or are supervised by adults who are not their parents or relatives;

  • Health care worker means a person other than a health care professional who provides medical, dental, or other health-related care or treatment under the direction of a health care professional with the authority to direct that individual's activities, including medical technicians, medical assistants, dental assistants, orderlies, aides, and individuals acting in similar capacities.

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

  • Medicare cost report means CMS-2552-10, the cost report for electronic filing of

  • The Contractor/ Vendor means the individual or firm or company undertaking the works and shall include legal personal representative of individual or composing the firm or company and the permitted assignees of individual or firms of company.

  • HMO a health maintenance organization doing business as such (or required to qualify or to be licensed as such) under HMO Regulations.

  • Direct care worker means a paid individual who provides direct, personal care services to persons with disabilities or the elderly requiring long-term care (see also the definition of long-term care worker, which includes direct care workers).

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).

  • Child care facility or “facility” means a child care center, a preschool, or a registered child development home.

  • Third Party Vendor means any person or entity that provides SaaS, third party software and/or related intellectual property. “Work” means any additional work the Customer requests Singtel to perform in relation to the Service.

  • Mail order pharmacy means a pharmacy licensed by this

  • HIPAA means the Health Insurance Portability and Accountability Act of 1996, as amended.

  • Contractor Personnel means Contractor’s employees and subcontractors (as well as any employees or subcontractors of those subcontractors) performing the Services.

  • Supplier/Contractor means the individual, firm or company with whom the contract has been concluded for supplying the Goods and Services under the Contract. The Supplier/Contractor shall be deemed to include its successors (approved by the purchaser), representatives, heirs, executors, administrators and permitted;

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.