Medicare Advantage Organization definition

Medicare Advantage Organization means a public or private organization licensed by the State as a risk-bearing entity that is under contract with CMS to provide the Medicare Advantage Benefit Package as defined in this Agreement.
Sample 1Sample 2Sample 3
Medicare Advantage Organization means a public or private entity organized and licensed by a State as a risk-bearing entity (with the exception of provider-sponsored organizations receiving waivers) that is certified by CMS as meeting the Medicare Advantage contract requirements.
Sample 1Sample 2Sample 3
Medicare Advantage Organization means a private company that has a contract with Medicare to provide Medicare Advantage plans and benefits to individuals.
Sample 1Sample 2Sample 3

Examples of Medicare Advantage Organization in a sentence

  • Risk adjustment is the process used by CMS to adjust the payment made to the Medicare Advantage Organization based on the health status of the Medicare Advantage Organization’s Medicare Advantage members.

  • Under the CMS risk adjustment model, the Medicare Advantage Organization is permitted to submit diagnosis data from inpatient hospital, outpatient hospital and physician encounters only.

  • Medical Record Documentation Requirements (Risk Adjustment)Medical records significantly impact risk adjustment because:• They are a valuable source of diagnosis data;• They dictate what ICD-10 Code is assigned;• They are used to validate diagnosis data that was previously provided to CMS by the Medicare Advantage Organization.

  • If the Medicare Advantage Organization is selected by CMS to participate in a RADV audit, the Medicare Advantage Organization and the providers that treated the MA members included in the audit will be required to submit medical records to validate the diagnosis data previously submitted.

  • CMS requires that specific terms and conditions be incorporated into the Agreement between a Medicare Advantage Organization or First Tier Entity and a First Tier Entity or Downstream Entity to comply with the Medicare laws, regulations, and CMS instructions, including, but not limited to, the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Pub.

  • Benefit Plans sponsored, issued or administered by a Medicare Advantage Organization as part of the Medicare Advantage program or as part of the Medicare Advantage program together with the Prescription Drug program under Title XVIII, Part C and Part D, respectively, of the Social Security Act (as those program names may change from time to time).

  • MS and, where applicable, Frontex, carefully select participants taking into account their particular functions in RO and RI and ensure that, prior to their participation, they have received appropriate training in relevant Union and international law, including on the protection of fundamental rights and access to international protection.

  • In addition, the provider has contractually agreed to certify the accuracy, completeness and truthfulness of the provider’s generated encounter data that the Medicare Advantage Organization is obligated to submit to CMS.

  • HFHP”), a Medicare Advantage Organization, irrevocably assigned all rights to recover conditional payments made on behalf of its Enrollees to MSP Recovery, LLC (the “HFHP Assignment”).

  • This certification shall be provided in writing and in the specified format at the request of the Medicare Advantage Organization.


More Definitions of Medicare Advantage Organization

Medicare Advantage Organization. (“MA Organization”): A public or private entity organized and licensed by a state as a risk-bearing entity (with the exception of provider-sponsored organizations receiving waivers) that is certified by CMS as meeting the MA contract requirements.
Sample 1Sample 2Sample 3
Medicare Advantage Organization means a private company that has a contract with Medicare to provide Medicare Advantage plans and benefits to individuals.37.36(2) Guaranteed issue.
Sample 1Sample 2
Medicare Advantage Organization means a public or private entity organized and licensed by a state Governmental Authority as a risk-bearing entity
Sample 1
Medicare Advantage Organization. (“MAO”) means a Health Plan that has entered into an agreement with the CMS to provide services to Medicare beneficiaries under the Medicare Advantage Program.
Sample 1
Medicare Advantage Organization means an organization holding a contract with CMS to offer a Medicare Advantage Plan to eligible beneficiaries of Medicare.
Sample 1

Related to Medicare Advantage Organization

  • Medicare Advantage plan means a plan of coverage for health benefits under Medicare Part C as defined in 42 U.S.C. 1395w-28(b)(1), and includes:

  • Health care organization ’ means any person or en-

  • Managed care organization means an entity that (1) is under contract with the department to provide services to Medicaid recipients and (2) meets the definition of “health maintenance organization” as defined in Iowa Code section 514B.1.

  • Provider Organization means a group practice, facility, or organization that is:

  • Managed Care Organization (MCO) means a contracted health delivery system providing capitated or prepaid health services, also known as a Prepaid Health Plan (PHP). An MCO is responsible for providing, arranging, and making reimbursement arrangements for covered services as governed by state and federal law. An MCO may be a Chemical Dependency Organization (CDO), Dental Care Organization (DCO), Mental Health Organization (MHO), or Physician Care Organization (PCO).

  • Procurement organization means an eye bank, organ procurement organization, or tissue bank.

  • Religious organization means a church, ecclesiastical corporation, or group, not organized for pecuniary profit, that gathers for mutual support and edification in piety or worship of a supreme deity.

  • Foreign terrorist organization means an organization designated as a foreign terrorist organization by the United States secretary of state as authorized by 8 U.S.C. Section 1189.

  • Nonprofit organization means an organization that is exempt from federal income taxation pursuant to Section 501(a) of the Code and described in Section 501(c) of the Code and that has as one of its designated activities, as indicated on United States Internal Revenue Service form 1023 "recognition of exemption", an activity that is directly related to the purposes for which grants may be issued under Revised Code Sections 164.20 through 164.27 as described in divisions (A) and (B) of Revised Code Section 164.22

  • Credit union service organization means an organization, corporation, or association whose membership or ownership is primarily confined or restricted to credit unions or organizations of credit unions and whose purpose is primarily designed to provide services to credit unions, organizations of credit unions, or credit union members.

  • Review organization means a disability insurer regulated

  • Student organization means a group, club or organization having students as its primary members or participants. It includes grade levels, classes, teams, activities or particular school events. A student organization does not have to be an official school organization to come within the terms of this definition.

  • Labor organization means any organization of any kind, or any agency or employee representation committee or plan, in which employees participate and that exists for the purpose, in whole or in part, of dealing with employers concerning grievances, labor disputes, wages, rates of pay, hours of employment, or conditions of work.

  • Member organization means any individual, corporation, limited liability company, partnership, or association that belongs to an association.

  • Employee organization means any organization, union, or

  • Coordinated care organization means an organization meeting criteria adopted by the

  • Professional employer organization means an employee leasing

  • Educational organization means a nonprofit public or private elementary or

  • Health care facility or "facility" means hospices licensed

  • Business organization means an individual, partnership, association, joint stock company, trust, corporation or other legal business entity or successor thereof.

  • Organ procurement organization means a person designated by the Secretary of the United States Department of Health and Human Services as an organ procurement organization.

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

  • Foreign organization means an organization created under laws other than the laws of this state for a purpose for which an organization may be created under the laws of this state.

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

  • Indian organization means the governing body of any Indian tribe or entity established or recognized by the governing body of an Indian tribe for the purposes of 25 U.S.C., chapter 17.

  • 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.