MSN Enrollee definition

MSN Enrollee or “Enrollee” means a person, enrolled in the MSN Program, meeting the 12 eligibility criteria set by ADMINISTRATOR in order to meet its obligations under W&I 17000.
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MSN Enrollee or "Enrollee" means a person, enrolled in the MSN Program, meeting the
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Examples of MSN Enrollee in a sentence

  • For emergency department visits, CONTRACTOR shall collect a three hundred dollar 27 ($300) co-payment from MSN Enrollees; provided, however, if the MSN Enrollee is admitted directly 28 from the Emergency Room to CONTRACTOR’s facility or lower level of care, including Recuperative 29 Care, the co-payment for the emergency department visit shall be waived.

  • If CONTRACTOR has an MSN Enrollee, who is Medically Stable as defined under 7 EMTALA, that requires Special Permit Medical Services, CONTRACTOR shall contact the CCU to 8 request the transfer of said MSN Enrollee to, at the discretion of ADMINISTRATOR, a Contracting 9 Hospital or other facility capable of providing said services.

  • For emergency department visits CONTRACTOR shall collect a three hundred dollar 33 ($300) co-payment from MSN Enrollees; provided, however, if the MSN Enrollee is admitted directly 34 from the Emergency Room to CONTRACTOR’s facility or lower level of care, including Recuperative 35 Care, the co-payment for the emergency department visit shall be waived.

  • Any Hospital that does not become a Contracting ED Hospital or Contracting Hospital and 14 elects to provide any Hospital Services to any MSN Enrollee shall be reimbursed by COUNTY at the 15 Non-Contract Hospital rates.

  • ADMINISTRATOR may negotiate, as reimbursement for accepting a Medically Stable 29 MSN Enrollee, as defined under EMTALA, Special Permit Transfer, rates appropriate for securing care, 30 as mutually agreed upon, in writing, between the other facility and ADMINISTRATOR.

  • CONTRACTOR shall review all claims to determine whether the services for which 3 reimbursement is sought are Medical Services, reimbursable pursuant to the Agreement, and whether 4 such services were rendered to an MSN Enrollee.

  • Non-Contract Hospital must send MSN Enrollee information to the CCU for concurrent 36 review within seventy-two (72) hours of the MSN Enrollee’s admission to Non-Contract Hospital’s 37 facility.

  • Any Hospital that does not become a Contracting ED Hospital or Contracting Network 2 Hospital and elects to provide any Hospital Services to any MSN Enrollee shall be reimbursed by 3 COUNTY at the Non-Contract Hospital rates.

  • If an MSN Enrollee requires acute psychiatric care, ADMINISTRATOR will make every 4 reasonable best effort to facilitate the transfer of the MSN Enrollee to a hospital or health care facility 5 that is operated by or has contracted with COUNTY to provide such acute psychiatric treatment.

  • For emergency department visits CONTRACTOR shall collect a three hundred dollar 21 ($300) co-payment from MSN Enrollees; provided, however, if the MSN Enrollee is admitted to 22 CONTRACTOR’s facility, or directly to a Contracting Hospital or lower level of care, including 23 Recuperative Care, the co-payment for the emergency department visit shall be waived.

Related to MSN Enrollee

  • Enrollee means any person entitled to health care services from a carrier.

  • Potential Enrollee means a Medical Assistance Recipient who may voluntarily elect to enroll in a given managed care program, but is not yet an Enrollee of an MCO.

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

  • Late enrollee means an eligible employee or dependent who

  • Family child care provider means a person who: (a) Provides

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Health plan or "health benefit plan" means any policy,

  • Newborn means a baby less than nine days old.

  • Radiologist assistant means an individual who has met the requirements of the Board for licensure

  • 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.

  • Open enrollment means a period of time as defined in rule

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • 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).

  • Pharmacy benefits management means the administration or management of prescription drug

  • 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).

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

  • CMS means the Centers for Medicare and Medicaid Services.

  • Audiologist means an individual who is licensed by a state to practice audiology.

  • 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.

  • Radiologist means a medical practitioner who specialises in the provision of radiological services within the meaning of the Health Insurance Act 1973.

  • Behavioral health provider means a person licensed under 34 chapter 18.57, 18.57A, 18.71, 18.71A, 18.83, 18.205, 18.225, or 18.79

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

  • Non-Participating Certified Clinical Nurse Specialist means a Certified Clinical Nurse Specialist who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Service Provider Number Portability (SPNP) is synonymous with Permanent Number Portability “PNP”.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Pharmacy benefits manager means a person that performs pharmacy benefits management.