Prepaid Capitation definition

Prepaid Capitation means the aggregate of all prepaid capitation amounts paid in advance with respect to the Reinsured Policies determined in accordance with SAP and appropriately includable on line 22 of the Assets page of the 2000 NAIC Annual Statement Blank, on line 24 of the Assets page of the 2001 NAIC Annual Statement Blank, or in comparable line items on successor NAIC Annual Statement Blanks, in each case whether or not such prepaid capitation amounts are admitted assets for statutory reporting purposes.
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Prepaid Capitation means an annual fixed premium per person paid in advance for a specified set of comprehensive health benefits.
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Prepaid Capitation means an arrangement whereby the dentist providing services is compensated through capitation on the basis of the presence of an enrollee regardless of whether services are provided.]
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Examples of Prepaid Capitation in a sentence

  • As of the Effective Date of Enrollment, and until the Effective Date of Disenrollment from the Contractor's Medicaid Advantage Plus Product, the Contractor shall be responsible for the provision and cost of the Medicaid Services as described in Appendix K-2 of this Agreement for Enrollees whose names appear on the Prepaid Capitation Plan Roster.

  • Managed Care Organizations (also referred to as Prepaid Capitation Plans) cover the care of many Medicaid enrollees and may have other qualifications for participation and offer additional services.

  • MA Recipient Enrollment MA recipients will be enrolled in the Prepaid Capitation Program (PCP) Subsystem of WMS.

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  • Refer to the codes section for a complete listing of county codes.RECIPIENT’S MEDICAID COVERAGEELIGIBLE CAPITATION GUARANTEEA response of “Eligible Capitation Guarantee” indicates guaranteed status under a Prepaid Capitation Program (PCP).

  • As of the Effective Date of Enrollment, and until the Effective Date of Disenrollment from the Contractor's product, the Contractor shall be responsible for the provision and cost of the Medicaid Advantage Benefit Package as described in Appendix K-2 of this Agreement for Enrollees whose names appear on the Prepaid Capitation Plan Roster.

  • RESPONSE/RETURNPOSSIBLE CAUSESN SERVICES RESTRICTED TO THE FOLLOWING PROVIDERSERVICES RESTRICTED TO THE FOLLOWING PROVIDERFor restricted clients, this response is returned if the ordering provider entered is not who the client is restricted to.R OTHER OR ADDITIONAL PAYERELIGIBLE CAPITATION GUARANTEEA response of “Eligible Capitation Guarantee” indicates guaranteed status under a Prepaid Capitation Program (PCP).

  • The Medicaid program does not reimburse for any service that is excluded from the benefit package of the FHP Managed Care Plan.MC MANAGED CARE COORDINATORELIGIBLE PCPA response of “Eligible PCP” indicates coverage under a Prepaid Capitation Program (PCP).

  • MESSAGE SEQUENCERESPONSEDESCRIPTION/COMMENTSCINMEDICAID NUMBER AA22346DThe response begins with the client’s eight-digit Medicaid CIN.COUNTY CODECOUNTY CODE XXThe two-digit code which indicates the client’s county of fiscal responsibility.Refer to Section 13.4 on page 13.4.1 for county codes.CLIENT’S MEDICAID COVERAGEELIGIBLE CAPITATION GUARANTEEA response of “Eligible Capitation Guarantee” indicates guaranteed status under a Prepaid Capitation Program (PCP).

  • MESSAGE SEQUENCERESPONSEDESCRIPTION/COMMENTSRECIPIENT’S MEDICAIDCOVERAGE (contd.)ELIGIBLE PCPA response of “Eligible PCP” indicates coverage under a Prepaid Capitation Program (PCP).

Related to Prepaid Capitation

  • Capitation means the reimbursement arrangement in which a fixed rate of payment per Enrollee per month is made to the Contractor for the performance of all of the Contractor’s duties and obligations pursuant to this Contract.

  • Capitation rate means the fee the department pays monthly to an HMO for each enrolled recipient for the provision of covered medical and health services whether or not the enrolled recipient received services during the month for which the fee is intended.

  • Prepaid Card means the MasterCard Prepaid Card that you have purchased from us;

  • Prepaid wireless calling service means a telecommunications service that provides the right to utilize mobile wireless service as well as other non-telecommunications services, including the download of digital products delivered electronically, content and ancillary services, which must be paid for in advance that is sold in predetermined units or dollars of which the number declines with use in a known amount.

  • Capitation Payment means a payment the STATE makes periodically to the MCO for each Enrollee covered under the Contract for the provision of services as defined in Article 6 regardless of whether the Enrollee receives these services during the period covered by the payment.

  • Prepaid calling service means the right to access exclusively telecommunications services, which must be paid for in advance and which enables the origination of calls using an access number or authorization code, whether manually or electronically dialed, and that is sold in predetermined units or dollars of which the number declines with use in a known amount.

  • Poverty line means the nonfarm federal poverty line for the continental United States, as defined by the federal department of labor under 42 USC 9902 (2).

  • Balance billing means charging or collecting an amount in excess of the Medicaid, Medicare, or contracted reimbursement rate for services covered under a Medicaid, Medicare or employer sponsored beneficiary’s plan. “Balance Billing” does not include charging or collecting deductibles or copayments and coinsurance required by the beneficiary’s plan.

  • 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.

  • Skilled Nursing Care means that level of care which:

  • Toll Billing Exception Service (TBE) means a service that allows End Users to restrict third number billing or collect calls to their lines.

  • Mail order pharmacy means a pharmacy licensed by this

  • Prepaid contract means any Contract that has terminated or been prepaid in full prior to its scheduled expiration date (including because of a Casualty Loss), other than a Defaulted Contract.

  • Nursing home-type patients means a patient who has been in hospital more than 35 days, no longer requires acute hospital care, cannot live independently at home or be looked after at home, and either cannot be placed in a nursing home or a nursing home place is not available.

  • Diameter at Breast Height (DBH) means the diameter of a tree at 4 1/2 feet above the ground measured from the uphill side.

  • Unsubsidized Xxxxxxxx Loan means a Loan made pursuant to Section 428H of the Higher Education Act.

  • Busy Line Verification (BLV means a service whereby an End User requests an operator to confirm the busy status of a line.

  • payment initiation service means a service to initiate a payment order at the request of the payment service user with respect to a payment account held at another payment service provider;

  • Subsidized Xxxxxxxx Loan means a Loan for which the interest rate is governed by Section 427A(a) or 427A(d) of the Higher Education Act.

  • 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.

  • Intermodal Rail Yard means a rail facility in which cargo is transferred from drayage truck to train or vice-versa.

  • Adult day care means a program for six (6) or more individuals, of social and health-related services provided during the day in a community group setting for the purpose of supporting frail, impaired elderly or other disabled adults who can benefit from care in a group setting outside the home.

  • Provider network means an affiliated group of varied health care providers that is established to provide a continuum of health care services to individuals;

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

  • Vapor balance system means a combination of pipes or hoses which create a closed system between the vapor spaces of an unloading tank and a receiving tank such that vapors displaced from the receiving tank are transferred to the tank being unloaded.

  • Voice mail service means an ancillary service that enables the customer to store, send or receive recorded messages. Voice mail service does not include any vertical services that the customer may be required to have in order to utilize the voice mail service.