Potential Enrollee definition
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.
Potential Enrollee means a Medicaid Member who is subject to mandatory enrollment or may voluntarily elect to enroll in a given Managed Care Program, but is not yet an Enrollee of a specific PMHP. Prepaid Ambulatory Health Plan (PAHP) means an entity that provides medical services to Enrollees under contract with the Department and on the basis of prepaid Capitation Payments, or other payment arrangements that do not use State Plan payment rates; does not provide or arrange for, and is not otherwise responsible for the provision of any inpatient hospital or institutional services for its Enrollees; and does not have a Comprehensive Risk Contract. Prepaid Inpatient Health Plan (PIHP) means an entity that:
Potential Enrollee means a MMC Eligible Person who is not yet enrolled in a MCO that is participating in the MMC Program.
Examples of Potential Enrollee in a sentence
An Enrollee or Potential Enrollee, or the spouse, sibling, child, or unpaid primary caregiver of an Enrollee or Potential Enrollee.
Such statements can include that the Potential Enrollee must enroll with the Contractor in order to obtain or not to lose benefits; or that the Contractor has been endorsed by CMS, the federal or State government, or similar entity.
More Definitions of Potential Enrollee
Potential Enrollee means an Eligible Person as defined in this Agreement who has not yet enrolled in the Contractor’s Medicaid Advantage Plus Product.
Potential Enrollee means a Medicaid recipient who is subject to mandatory enrollment or may voluntarily elect to enroll in a given managed care program, but is not yet an enrollee of a specific Health Plan.
Potential Enrollee means a Medicaid recipient who is subject to mandatory enrollment or may voluntarily elect to enroll in a given managed care program, but is not yet an enrollee of a specific MCO or PCCM.
Potential Enrollee means a Medicaid recipient who is subject to mandatory enrollment or may voluntarily elect to enroll in a given managed care program, but is not yet assigned to a specific primary care provider.
Potential Enrollee means a Medicaid eligible recipient who is not enrolled with a Contractor [42 CFR 438.10(a)].
Potential Enrollee means a recipient who is authorized by the Department to enroll in a managed care organization.
Potential Enrollee means a Medicaid member who is subject to mandatory enrollment or may voluntarily elect to enroll in a given Managed Care Program, but is not yet an Enrollee of a specific MCE. Prepaid Ambulatory Health Plan (PAHP) means an entity that provides medical services to Enrollees under contract with the Department and on the basis of prepaid Capitation Payments, or other payment arrangements that do not use State Plan payment rates; does not provide or arrange for, and is not otherwise responsible for the provision of any inpatient hospital or institutional services for its Enrollees; and does not have a Comprehensive Risk Contract. Prepaid Inpatient Health Plan (PIHP) means an entity that provides medical services to Enrollees under contract with the Department, and on the basis of prepaid Capitation Payments, or other payment arrangements that do not use State Plan payment rates; provides, arranges for, or otherwise has responsibility for the provision of inpatient hospital or Prepaid Mental Health Plan (PMHP) means the Medicaid mental health and substance use disorder managed care plan that covers inpatient and outpatient mental health services and outpatient substance use disorder services. Primary Care Case Management (PCCM) means a system under which a PCCM contracts with the Department to furnish case management services (which include the location, coordination and monitoring of primary health care services) to Medicaid members. Provider means a Network Provider or a Non-Network Provider. Quality Assessment and Performance Improvement Program (QAPI Program or QAPIP) means the Contractor’s plan to establish and implement an ongoing comprehensive quality assessment and performance improvement program for the services it furnishes to its Enrollees in accordance with 42 CFR 438.330. Rate Cell means a set of mutually exclusive categories of Enrollees that is defined by one or more characteristics for the purpose of determining the Capitation Rate and making a Capitation Payment; such characteristics may include age, gender, eligibility category, and region or geographic area. Each Enrollee is categorized in one of the Rate Cells for each unique set of mutually exclusive benefits under the Contract. Rating Period means a period of 12 months selected by the Department for which the actuarially sound Capitation Rates are developed and documented in the rate certification submitted to CMS as required by 42 CFR 438.7(a).