Provider Incentive definition
Examples of Provider Incentive in a sentence
Provider Incentive – An additional amount of compensation paid to a health care Provider by a payer, based on the Provider's compliance with agreed-upon procedural and/or outcome measures for a particular group or population of covered persons.
In accordance with 42 CFR 422.208, the Contractor may operate a Provider Incentive Plan only if the Contractor makes no specific payment, directly or indirectly, to a physician or physician group as an inducement to reduce or limit Medically Necessary services furnished to any particular Enrollee.
In some cases, recovery of claim payments associated with a retroactive cancellation may not be possible if, as an example, the recovery (a) conflicts with the Host Blue’s state law or healthcare provider contracts, (b) would result from Shared Savings and/or Provider Incentive arrangements or (c) would jeopardize the Host Blue’s relationship with its participating healthcare providers, notwithstanding to the contrary any other provision of this Agreement.
In accordance with 42 CFR 422.208, the Contractor may operate a Provider Incentive Plan only if the Contractor makes no specific payment, directly or indirectly, to a provider or provider group as an inducement to reduce or limit Medically Necessary services furnished to any particular Enrollee.
The Contractor shall notify the Department if the Contractor plans to operate a Provider Incentive Plan.
The Contractor shall provide information on its Provider Incentive Plan to any Enrollee upon request.
In some cases, recovery of Claim Payments associated with a retroactive cancellation may not be possible if, as an example, the recovery (a) conflicts with the Host Blue's state law or health care Provider contracts, (b) would result from Shared Savings and/or Provider Incentive arrangements, or (c) would jeopardize the Host Blue's relationship with its Participating Healthcare Providers, notwithstanding to the contrary any other provision of this Agreement.
Provider Incentive – An additional amount of compensation paid to a healthcare Provider by a payer, based on the Provider's compliance with agreed-upon procedural and/or outcome measures for a particular group or population of covered persons.
In some cases, recovery of claim payments associated with a retroactive cancellation may not be possible if, as an example, the recovery (a) conflicts with the Host Blue’s state law or healthcare provider contracts, (b) would result from Shared Savings and/or Provider Incentive arrangements, and Care Coordination Fees or (c) would jeopardize the Host Blue’s relationship with its participating healthcare providers, notwithstanding to the contrary any other provision of this Agreement.
If applicable, the Linguistic Competence Provider Incentive amount will be paid in full along with the first half of the Grant Amount.