Participating Medicaid MCO definition

Participating Medicaid MCO means a Medicaid MCO that a Participating Medicaid Program has determined is eligible for Supplemental Rebates consistent with the applicable Participating Medicaid Program’s Medicaid Plan and the applicable Participating Medicaid Program’s contract with the Medicaid MCO. In order to qualify as a “Participating Medicaid MCO”, the Medicaid MCO must have aligned its formulary and/or preferred drug list, as applicable, with the PDL, assuring access to Supplemental Covered Product is no more restrictive than the Participating Medicaid Program PDL requirements applicable to the Supplemental Covered Product.
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Participating Medicaid MCO means a Medicaid MCO that is contracted with the DMMA to supply a prescription drug benefit to Delaware Medicaid Recipients. In order to qualify as a “Participating Medicaid MCO”, the Medicaid MCO must have aligned its formulary and/or Preferred Drug List, as applicable, with the DMMA Fee-for-Service Program Preferred Drug List, assuring access to a Preferred Product is no more restrictive than the DMMA Fee-for-Service Program Preferred Drug List requirements applicable to the Preferred Product.
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Participating Medicaid MCO means a Medicaid MCO that the State has determined is eligible for Supplemental Rebates consistent with the State Medicaid Plan and the State’s contract with the Medicaid MCO. In order to qualify as a Participating Medicaid MCO, the Medicaid MCO must have aligned its formulary and/or preferred drug list, as applicable, with the State’s PDL, assuring access to Covered Product(s) is no more restrictive than the State PDL requirements applicable to the Supplemental Covered Product.
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Examples of Participating Medicaid MCO in a sentence

  • For the avoidance of doubt, as is the case with National Rebates, Supplemental Rebates applicable to Participating Medicaid MCO utilization shall be payable to the Participating Medicaid Programs, and shall not be paid directly to the Participating Medicaid MCOs, notwithstanding that the Participating Medicaid MCO utilization may be invoiced separately from fee-for-service Medicaid utilization.

  • Supplemental Rebates shall begin to accrue to Participating Medicaid MCO(s) pursuant to this Participation Agreement for a Covered Product upon the later of: (i) Magellan Medicaid receiving the applicable State’s complete and executed Attachment A-2 (along with any required attachments) electing to include Participating Medicaid MCO utilization hereunder, or (ii) effective date for such Participating Medicaid MCO utilization, as set forth on Attachment A-2.

  • 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.

  • Supplemental Rebates shall begin to accrue to any new Participating Medicaid MCO pursuant to this Agreement for a Supplemental Covered Product upon the later of: (i) Administrator receiving the applicable State’s complete and executed Attachment A-2 electing to include Participating Medicaid MCO utilization hereunder, or (ii) effective date for such Participating Medicaid MCO utilization, as set forth on Attachment A-2.

  • Supplemental Rebates shall begin to accrue to Participating Medicaid MCO(s) pursuant to this Participation Agreement for a Covered Product upon the later of: (i) Magellan Medicaid receiving the applicable State’s complete and executed Attachment A‐2 (along with any required attachments) electing to include Participating Medicaid MCO utilization hereunder, or (ii) effective date for such Participating Medicaid MCO utilization, as set forth on Attachment A‐2.

Related to Participating Medicaid MCO

  • Non-Participating Retail Health Clinic means a Retail Health Clinic which 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.

  • Medicaid program means the Kansas program of medical

  • Non-Participating Clinical Social Worker means a Clinical Social Worker 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.

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

  • Non-Participating Orthotic Provider means an Orthotic Provider 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.

  • Non-Participating Prosthetic Provider means a Prosthetic Provider 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.

  • Participating Retail Health Clinic means a Retail Health Clinic which has 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.

  • Participating Prosthetic Provider means a Prosthetic Provider who has 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.

  • Participating Merchant means a Merchant that offers the Online Payment Service as an online payment option on the Merchant’s website.

  • Participating Orthotic Provider means an Orthotic Provider who has 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.

  • Participating Clinical Social Worker means a Clinical Social Worker who has 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.

  • Participating Clinical Laboratory means a Clinical Laboratory which has 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.

  • Non-Participating Manufacturer means any Tobacco Product Manufacturer that is not a Participating Manufacturer.

  • Participating manufacturer means that term as defined in the master settlement agreement.

  • Participating student means a student who has been determined to be

  • Participating Dentist means any Dentist who, at the time of rendering a Covered Dental Service to the Member, has a written agreement with CareFirst BlueChoice or the Dental Plan for the rendering of such service.

  • Participating Prescription Drug Provider means an independent retail Pharmacy, chain of retail Pharmacies, mail-order Pharmacy or specialty drug Pharmacy which has entered into an agreement to provide pharmaceutical services to participants in the benefit program. A retail Participating Pharmacy may or may not be a select Participating Pharmacy as that term is used in the Vaccinations Obtained Through Participating Pharmacies section.

  • Participating Pharmacy means a pharmacy that has entered into a prescription drug plan agreement with the Pharmacy Benefit Manager listed on your identification card.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

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

  • Qualified medical provider means the same as that term is defined in Section 26-61a-102.

  • 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.

  • Non-Participating Certified Nurse Practitioner means a Certified Nurse Practitioner 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.

  • Non-Participating Clinical Professional Counselor means a Clinical Professional Counselor 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.

  • 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:

  • Non-Participating Certified Nurse-Midwife means a Certified Nurse-Midwife 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.